Abstract
Laser focal therapy (LFT) is an evolving ablative technique for the treatment of prostate cancer. Also referred to as laser interstitial thermal therapy (LITT) or focal laser ablation (FLA), this intervention is based on heating of the prostate with an infrared laser to produce tissue destruction from coagulative necrosis. While earlier work focused on a transperineal approach, this has evolved to a less-invasive, transrectal approach delivered in the outpatient setting. This chapter examines the history, mechanism of action, and technique of transrectal magnetic resonance imaging (MRI)-guided LFT with real-time thermometry. We describe the equipment, procedure, and early safety and feasibility results of a series of patients in a clinical trial.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Phase II Laser Focal Therapy of Prostate Cancer (LITT or FLA). NCT02243033. clinicaltrials.gov/ct2/show/NCT02243033. Accessed 14 Feb 2016.
Oto A, Sethi I, Karczmar G, McNichols R, Ivancevic MK, Stadler WM, et al. MR imaging-guided focal laser ablation for prostate cancer: phase I trial. Radiology. 2013;267(3):932–40.
Garcia-Medina O, Gorny K, McNichols R, Friese J, Misra S, Amrami K, et al. In vivo evaluation of a MR-guided 980 nm laser interstitial thermal therapy system for ablations in porcine liver. Lasers Surg Med. 2011;43(4):298–305.
Stafford RJ, Shetty A, Elliott AM, Klumpp SA, McNichols RJ, Gowda A, et al. Magnetic resonance guided, focal laser induced interstitial thermal therapy in a canine prostate model. J Urol. 2010;184(4):1514–20.
Neff T. First-ever targeted laser prostate surgery a success. UCH Insider. 2009;3(8). http://www3.uch.edu/uchinsider/laser%20prostate%20surgery.pdf
MR-Guided Laser Ablation of Prostate Bed Recurrences. NCT01743638. https://clinicaltrials.gov/ct2/show/NCT01743638. Accessed 15 Sept 2016.
MRI Targeted Focal Laser Thermal Therapy of Biopsy Confirmed Prostate Cancer. NCT00448695. https://clinicaltrials.gov/ct2/show/NCT00448695. Accessed 15 Sept 2016.
MR-Guided Laser Interstitial Thermal Therapy in Treating Patients with Prostate Cancer. NCT01792024. https://clinicaltrials.gov/ct2/show/NCT01792024. Accessed 15 Sept 2016.
Raz O, Haider MA, Davidson SR, Lindner U, Hlasny E, Weersink R, et al. Real-time magnetic resonance imaging-guided focal laser therapy in patients with low-risk prostate cancer. Eur Urol. 2010;58(1):173–7.
Lindner U, Lawrentschuk N, Weersink RA, Davidson SR, Raz O, Hlasny E, et al. Focal laser ablation for prostate cancer followed by radical prostatectomy: validation of focal therapy and imaging accuracy. Eur Urol. 2010;57(6):1111–4.
Woodrum DA, Mynderse LA, Gorny KR, Amrami KK, McNichols RJ, Callstrom MR. 3.0 T MR-guided laser ablation of a prostate cancer recurrence in the postsurgical prostate bed. J Vasc Interv Radiol. 2011;22(7):929–34.
Wenger H, Yousuf A, Oto A, Eggener S. Laser ablation as focal therapy for prostate cancer. Curr Opin Urol. 2014;24(3):236–40.
Curry DJ, Gowda A, McNichols RJ, Wilfong AA. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav. 2012;24(4):408–14.
Carpentier A, Chauvet D, Reina V, Beccaria K, Leclerq D, McNichols RJ, et al. MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med. 2012;44(5):361–8.
Beyersdorff D, Winkel A, Hamm B, Lenk S, Loening SA, Taupitz M. MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. Radiology. 2005;234(2):576–81.
Schertz A. Advancements improve prostate exams. BizTimes. Aug 20, 2010.
Donaldson IA, Alonzi R, Barratt D, Barret E, Berge V, Bott S, et al. Focal therapy: patients, interventions, and outcomes–a report from a consensus meeting. Eur Urol. 2015;67(4):771–7.
Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. The RAND/UCLA appropriateness method user’s manual. Santa Monica, CA: RAND Corporation; 2001 .http://www.rand.org/pubs/monograph_reports/MR1269.html
van der Poel H, Klotz L, Andriole G, Azzouzi AR, Bjartell A, Cussenot O, et al. Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers. World J Urol. 2015;33(7):907–16.
Abd-Alazeez M, Ahmed HU, Arya M, Charman SC, Anastasiadis E, Freeman A, et al. The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level–can it rule out clinically significant prostate cancer? Urol Oncol. 2014;32(1):45.e17–22.
Fütterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, et al. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol. 2015;68(6):1045–53.
Shigemura K, Yamanaka N, Yamashita M. Can diffusion-weighted magnetic resonance imaging predict a high Gleason score of prostate cancer? Korean J Urol. 2013;54(4):234–8.
Nagarajan R, Margolis D, Raman S, Sheng K, King C, Reiter R, et al. Correlation of Gleason scores with diffusion-weighted imaging findings of prostate cancer. Adv Urol. 2012;2012:374805.
deSouza NM, Riches SF, Vanas NJ, Morgan VA, Ashley SA, Fisher C, et al. Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer. Clin Radiol. 2008;63(7):774–82.
Hambrock T, Somford DM, Huisman HJ, van Oort IM, Witjes JA, van de Hulsbergen Kaa CA, et al. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 2011;259(2):453–61.
Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS prostate imaging – reporting and data system: 2015, Version 2. Eur Urol. 2016;69(1):16–40.
Medtronic Indications, Safety, and Warnings Visualase Thermal Therapy System. http://www.medtronic.com/for-healthcare-professionals/products-therapies/neurological/laser-ablation/visualase/indications-safety-warnings/index.htm. Accessed 5 Mar 2016.
U.S. Food and Drug Administration MAUDE Adverse Event Report Database. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=5101035. Accessed 8 Mar 2016.
Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol. 1996;155(2):607–9.
Soloway MS, Obek C. Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol. 2000163(1):172–3.
Le Nobin J, Orczyk C, Deng FM, Melamed J, Rusinek H, Taneja SS, et al. Prostate tumour volumes: evaluation of the agreement between magnetic resonance imaging and histology using novel co-registration software. BJU Int. 2014;114(6b):E105–12.
Whinnery JR, Ausubel J, Langford HD; National Academy of Engineering. Lasers: invention to application. Washington, DC: National Academy Press; 1987.
Ishihara Y, Calderon A, Watanabe H, Okamoto K, Suzuki Y, Kuroda K, et al. A precise and fast temperature mapping using water proton chemical shift. Magn Reson Med. 1995;34(6):814–23.
Rieke V, Butts Pauly K. MR thermometry. J Magn Reson Imaging. 2008;27(2):376–90.
Henriques FC. Studies of thermal injury, V. The predictability and significance of thermally induced rate processes leading to irreversible epidermal injury. Arch Pathol. 1947;43:489–502.
Pearce JA. Comparative analysis of mathematical models of cell death and thermal damage processes. Int J Hyperthermia. 2013;29(4):262–80.
McNichols RJ, Gowda A, Kangasniemi M, Bankson JA, Price RE, Hazle JD. MR thermometry-based feedback control of laser interstitial thermal therapy at 980 nm. Lasers Surg Med. 2004;34(1):48–55.
Lee T, Mendhiratta N, Sperling D, Lepor H. Focal laser ablation for localized prostate cancer: principles, clinical trials, and our initial experience. Rev Urol. 2014;16(2):55–66.
Lepor H, Llukani E, Sperling D, Fütterer JJ. Complications, recovery, and early functional outcomes and oncologic control following in-bore focal laser ablation of prostate cancer. Eur Urol. 2015;68(6):924–6.
Acknowledgments
The authors gratefully acknowledge the skill and expertise of our interventional radiologist, Stuart T. May, MD and our MRI technologist, Wes Jones, RT. We also acknowledge the early work of Roger J. McNichols, PhD, who saw the potential of light and harnessed it. Without him much of our work would have been impossible. We dedicate this chapter to him. BMG, JFF, and RJS.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Feller, J.F., Greenwood, B.M., Stafford, R.J. (2017). Transrectal Laser Focal Therapy of Prostate Cancer. In: Polascik, T. (eds) Imaging and Focal Therapy of Early Prostate Cancer. Current Clinical Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-49911-6_25
Download citation
DOI: https://doi.org/10.1007/978-3-319-49911-6_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49910-9
Online ISBN: 978-3-319-49911-6
eBook Packages: MedicineMedicine (R0)