Accurate imaging meets new treatment modality; MRI guided focal laser ablation for prostate cancer. The first 10 cases in Australia

Introduction & objectives: In the current era of increasing surveillance for low risk prostate cancer (PCa), the concept of partial prostatectomy or prostate lumpectomy is gaining recognition. We present our initial experience of MRI guided focal laser ablation of prostate cancer. The aim of the study was to assess the feasibility and safety to visualise, target and ablate the prostate cancer lesion in real time MRI. Methods: After ethics board approval was obtained, patients with mpMRI and biopsy proven focal prostate cancer lesion, were offered a transperineal MRI guided focal laser thermal ablation. Exclusion criteria were Gleason score > 7, PSA > 10, > cT2b, multiple or high volume lesion. The procedure was performed using a Siemens WideBore T3 MRI. Patients were placed in supine position utilising a transperineal MRI template in the first 7 patients and transrectal in the recent patients via Dynacad target localisation. Following sedation, urinary catheter was inserted. MRI was done for localisation of the template, or transrectal probe followed by Axial T2 high resolution fast spin echo for lesion localisation. An MRI compatible needle was inserted after calculating the trajectory of the laser fiber. The laser fiber replaced the needle trocar and thermal ablation was done under real time MRI thermal mapping, enabling visualisation of lesion the lesion being actively treated. Post ablation contrast MRI was performed to confirm the size and location of the treated area. Results: From February 2014, 10 patients, average age 59 years and PSA 4.5 ng/mL (range 2.4–7.7) were included in our study. Prior to the treatment, 5 patients had Gleason 7, and additional 5 had Gleason 6. All patients were treated as outpatients. Lesions were targeted and treated successfully and confirmed with post treatment contrast MRI. Treatment duration was on average 2 h and 1 h in recovery. One patient had a urinary retention post treatment, he was commenced on alpha-blocker, and catheter removed 5 days later. Two patients complained of perineal discomfort on the day of the procedure. Conclusion: This is the first Phase II trial of Focal treatment of PCa using Laser ablation, as an outpatient procedure in the southern hemisphere. We managed to delivery this treatment with no technical issues and with excellent patient's tolerance. This technique provides a precise targeting and tissue destruction of the lesion only and avoids unnecessary complications of treating the entire prostate. More studies should be done, with larger number of patients and long-term follow-up, to confirm the disease and biochemical free survival benefit of this technique.1 page(s