Mp25-04 13-Year Interim Results for Transrectally Delivered, Outpatient Mri-Guided Laser Focal Therapy of Prostate Cancer in a Treatment Naive Cohort

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I (MP25)1 May 2024MP25-04 13-YEAR INTERIM RESULTS FOR TRANSRECTALLY DELIVERED, OUTPATIENT MRI-GUIDED LASER FOCAL THERAPY OF PROSTATE CANCER IN A TREATMENT NAIVE COHORT John F. Feller, Bernadette M. Greenwood, Wes Jones, Steven Gunberg, Jeffrey J. Herz, and Robert J. Toth John F. FellerJohn F. Feller , Bernadette M. GreenwoodBernadette M. Greenwood , Wes JonesWes Jones , Steven GunbergSteven Gunberg , Jeffrey J. HerzJeffrey J. Herz , and Robert J. TothRobert J. Toth View All Author Informationhttps://doi.org/10.1097/01.JU.0001008692.26556.39.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the United States, new prostate cancer (PCa) cases for 2023 are estimated at 288,300 and deaths at 34,700 according to the American Cancer Society. Focal therapies for low risk and intermediate risk localized prostate cancer and salvage treatment are increasingly being explored. We sought to establish the efficacy of laser focal therapy to avoid side-effects of whole-gland therapy. Lasers have been used for soft tissue necrotization for decades. Our goal was to use a commercially available MR-guided biopsy system for insertion of a laser fiber into biopsy proven cancerous lesions facilitating ablation of MR-visible tumor with real-time thermometry. We aimed to investigate the efficacy of using MR-guided laser focal therapy for MR-visible prostate cancer using a transrectal approach in an outpatient setting for initial treatment. METHODS: Materials: We used a 1.5 Tesla MRI system for both image acquisition and real-time thermometry. Commercially available CAD software was used for image analysis and laser fiber placement into the area of biopsy-confirmed tumor. Laser focal therapy was delivered using a 15W, 980nm-1064nm diode laser and cooled or non-cooled laser fiber introduced transrectally using an MRI-compatible positioning device. MR imaging was used to monitor energy deposition, thermal maps, irreversible damage estimates and coagulation necrosis. Prostate specific antigen (PSA), validated surveys and mpMRI with 6 mo. follow-up biopsy were performed for assessment of outcomes. RESULTS: At 6 mo. post-procedure biopsy, 23.5% (N=59) were non-responders with clinically significant PCa (csPCa, excluding 3+3=6) in-field, 6.1% (N=17) had clinically significant out-of-field cancer, and the remaining 71.1% (N=175) were responders. We observed a 43.4% decrease in mean PSA at 12 months post therapy (from 7.47 to 4.23), and no statistically significant change in International Prostate Symptom Score (IPSS) and Sexual Health Inventory for Men (SHIM) scores. As our data has matured over the years, we observed a 94% failure-free survival rate and 98% metastasis-free survival. CONCLUSIONS: Our data indicate that outpatient, transrectally delivered MRI-guided laser focal therapy for prostate cancer is both safe and feasible. The precision and controllability achieved under MRI-guidance may have favorable results for cost effectiveness and quality of life without eliminating the possibility of whole-gland treatment in the patient's future. We will continue to follow these men for twenty years as part of an IRB-approved clinical trial (NCT# 02243033). The demonstrated efficacy of laser focal therapy over thirteen years warrants randomized controlled trials. Source of Funding: NCT# 02243033 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e404 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information John F. Feller More articles by this author Bernadette M. Greenwood More articles by this author Wes Jones More articles by this author Steven Gunberg More articles by this author Jeffrey J. Herz More articles by this author Robert J. Toth More articles by this author Expand All Advertisement PDF downloadLoading ...