Transrectal Laser Focal Therapy of Prostate Cancer
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.
KeywordsTransrectal Laser focal therapy Laser interstitial thermal therapy Focal laser ablation
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.
- 1.Phase II Laser Focal Therapy of Prostate Cancer (LITT or FLA). NCT02243033. clinicaltrials.gov/ct2/show/NCT02243033. Accessed 14 Feb 2016.Google Scholar
- 5.Neff T. First-ever targeted laser prostate surgery a success. UCH Insider. 2009;3(8). http://www3.uch.edu/uchinsider/laser%20prostate%20surgery.pdf
- 6.MR-Guided Laser Ablation of Prostate Bed Recurrences. NCT01743638. https://clinicaltrials.gov/ct2/show/NCT01743638. Accessed 15 Sept 2016.
- 7.MRI Targeted Focal Laser Thermal Therapy of Biopsy Confirmed Prostate Cancer. NCT00448695. https://clinicaltrials.gov/ct2/show/NCT00448695. Accessed 15 Sept 2016.
- 8.MR-Guided Laser Interstitial Thermal Therapy in Treating Patients with Prostate Cancer. NCT01792024. https://clinicaltrials.gov/ct2/show/NCT01792024. Accessed 15 Sept 2016.
- 16.Schertz A. Advancements improve prostate exams. BizTimes. Aug 20, 2010.Google Scholar
- 18.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
- 20.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.Google Scholar
- 27.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.
- 28.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.
- 30.Soloway MS, Obek C. Periprostatic local anesthesia before ultrasound guided prostate biopsy. J Urol. 2000163(1):172–3.Google Scholar
- 32.Whinnery JR, Ausubel J, Langford HD; National Academy of Engineering. Lasers: invention to application. Washington, DC: National Academy Press; 1987.Google Scholar
- 35.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.Google Scholar