Transperineal Focal Laser Ablation Shows Promise in Treating Localized Prostate Cancer

Findings from an international registry study indicate that transperineal focal laser ablation (TPLA) may serve as an effective treatment for carefully selected men diagnosed with localized prostate cancer. This approach appears to help avoid the side effects commonly associated with more aggressive therapies, such as full prostatectomy.

One year post-treatment, 83% of patients did not require any additional whole-gland therapies, while MRI demonstrated a high accuracy rate at detecting most clinically significant cancer recurrences.

Lead author Katelijne de Bie, MD, from the Department of Urology at Amsterdam University Medical Center, noted, "A lot of patients really would like to have focal treatment for prostate cancer rather than having a full prostatectomy, which can lead to incontinence and/or impotence.”

TPLA is a minimally invasive procedure that utilizes thin laser fibers inserted through the perineum into the prostate under ultrasound guidance. Laser energy is applied to the fibers to induce cell damage, effectively targeting the malignancy.

The research involved a cohort of 195 patients who underwent TPLA across four sites (three in Europe and one in the United States) from May 2018 to June 2023. The majority of the treated tumors were identified as PI-RADS 3 or higher lesions through MRI, later confirmed via biopsy, demonstrating a median tumor length of 11 mm.

To evaluate cancer recurrence, a combination of prostate-specific antigen (PSA) testing, MRI, and prostate biopsy was employed. The study reported a 17% incidence of biopsy-confirmed, clinically significant cancer recurrence, necessitating either repeat focal laser ablation or alternative treatments. Dr. de Bie remarked, "It shows this treatment is not perfect yet, but that it has great potential, because most of the patients do not have recurrence."

The rates of side effects in this patient population were significantly lower compared to those seen with other treatment modalities. Dr. Aytekin Oto, MD, from the University of Chicago, commented on the recurrence rate, stating, "17% is in line with what’s listed in the literature, and it’s closer to the lower end of that."

However, both doctors acknowledged that focal therapy may sometimes inadequately address the cancer, possibly resulting in residual disease or recurrence, which would require subsequent treatment. Dr. Oto emphasized the importance of careful tumor delineation, noting that MRI has occasionally underestimated tumor extent.

Dr. de Bie highlighted that MRI outcomes within six to twelve months following TPLA were predictive of cancer recurrence in the treated area. MRI accurately identified 81% of clinically significant recurrence cases, with a sensitivity of 83% and specificity of 89%.

In light of these findings, there is a consensus among the researchers on the need for standardized treatment and follow-up protocols to enhance the efficacy and benefits of TPLA. Dr. Oto remarked on the necessity for a multilayered diagnostic approach to ascertain precise tumor locations, thereby determining the appropriateness for focal ablation.

Dr. de Bie speculated that such a strategy could allow patients to undergo repeat procedures if necessary and potentially prevent the need for prostatectomy in the future.

For more detailed insights, refer to the study titled “One-year Follow-up after US-guided Transperineal Focal Laser Ablation of Localized Prostate Cancer: Worldwide Registry Study.”