Dr. Peter Pinto is one of the most respected urologic researchers in America. He is the Head of the Prostate Cancer Section of the Urologic Oncology Branch of the Center for Cancer Research (National Cancer Institute/National Institutes of Health). That’s a very long formal title for a man who is humble, personable and good-natured. His patients at the NCI esteem him because they recognize his commitment to establishing excellence in prostate cancer diagnosis and treatment.
At the 2015 AUA meeting in New Orleans, Dr. Pinto presented the most current results of his team’s ongoing evaluation of focal laser ablation (FLA) for treating prostate cancer.[i] He gave a succinct introduction, placing focal therapy within the context of alternatives to whole-gland treatments that, for many patients, may have been overkill for a cancer that might never have become life threatening—at the price of their urinary or sexual quality of life. He stated that prostate cancer is not multifocal in every case, and that a percentage of patients will qualify for a treatment aimed only at the tumor.
Dr. Pinto identified several sources of energy that effectively destroy cancer: HIFU (high intensity focused ultrasound), cryotherapy, photodynamic therapy, irreversible electroporation, and FLA. His team’s interest in FLA stems from the fact that it is compatible with MRI guidance, which gives excellent soft tissue images, allows for precise placement of the laser fiber within the tumor, and affords real-time monitoring of the ablation. These conditions make it ideal for the rigorous conditions and tracking that go into clinical studies.
Dr. Pinto cited a phase I clinical trial of MRI-guided FLA that a University of Chicago team conducted, with their results published in June, 2013.[ii] Phase I trials are designed to demonstrate that a new drug or treatment is safe and effective, and that’s exactly what the U or C study did. It was a small study with 12 men. At 6 months follow up, eight of them had no tumor at the ablation site; two had Gleason 6 cancer on the side of the gland not treated, and four had residual disease. None had significant changes in their pre-treatment urinary or sexual function.
Dr. Pinto’s group repeated this Phase I study design with 15 patients, and got similar results. It’s worth mentioning that repetition is a good thing in the world of science, because if similar or better results are obtained, it helps establish the reliability of what’s being tested. In the case of the NCI study, Dr. Pinto reported the results of their FLA study at one year follow-up:
- Any adverse events after treatment were minor
- There were no significant changes in urinary or sexual function
- 13 patients had no tumor at the ablation site
- 2 patients had residual disease (Gleason 6 on one core sample)
Dr. Pinto stated that his team concluded that FLA is safe and feasible, and generates preservation of sexual and urinary function. He called for a prospective phase II trial with expanded criteria, in order to get a better study of longer term efficacy of FLA. While many men might be wishing for long term data in order to persuade insurance companies to cover the cost of FLA treatment, Dr. Pinto’s presentation is a solid step forward. On behalf of myself and all who offer this treatment, we are immensely grateful for the high caliber of his team’s work.
[i] Presented by Peter Pinto http://www.urotoday.com/index.php?Itemid=2460&option=com_content&view=article&catid=1655&id=80746&utm_source=newsletter_2672&utm_medium=email&utm_campaign=aua-2015-day-2-afternoon-exclusives-051615
[ii] Oto A, Sethi I, Karczmar G et al. MR imaging-guided focal laser ablation for prostate cancer: phase I trial. Radiology. 2013 Jun;267(3):932–940.