If you or a loved one are diagnosed with prostate cancer, please research all of your options AFTER the urologist gives you his (or her’s). There are many alternatives out there including:
- Ultrasound HIFU (Ablatherm, Sonablate)
- MRI guided HIFU (Insightec)
- FLA (Visualase, CLS, Elasta)
- Gold Nanoparticle therapy (Aurolase)
- Photodynamic therapy
- Transurethral US guided ablation (TULSA)
- Proton beam therapy
- ….and others
If you are interested in FLA, please acquaint yourself with the procedure using the information on this web site or reach out to us by email contact or phone. To see if you are a candidate is easy and free– send your MRI using the portal on the website front page labeled “upload MRI” and email us any biopsy results and clinic notes from your urologist. Dr. Walser personally reviews these materials and then will schedule a videoconference with you, your spouse, significant other and even your physician! Everyone can be at a different location for these conferences–just need a laptop or smartphone and an email account! We can get you a review within 72 hours of receiving your information.
In the next few months, a manuscript titled “Focal laser ablation for prostate cancer: results in 120 patients” will be published in the Journal of Interventional Radiology. In a nutshell, these patients experienced no sexual or urinary side effects, returned to work 3 days after the procedure and had a 15% need for retreatment (only 2 had surgery or radiation after FLA).
I will post a link to the article as soon as it is available!
I met with several italian scientists last month!
Drs Giovanni Mauri and Gianluigi Patelli at the Congress of the Interventional Radiology Society in Europe (CIRSE). Their new laser was approved by FDA recently and we anticipate participating as a providing site in the US. The procedure is transperineal but uses small (21g) needles. Only local anesthesia and an outpatient procedure.
They published a small series of patients with good results.
About 70 patients. The mean prostate volume changed from 74 ml to 49 ml; mean post voiding volume from 151 to 30ml; mean IPSS score from 22,3 to 7,7 ; mean Qol score from 4,4 to 0,8.
The follow up range was 3-39 months (mean 14 months).
No major complications occurred.
For the appropriate candidates, focal therapies can provide the right balance between mitigating symptoms and monitoring the any progression of cancer.
- Side effects are less severe: The risk of erectile dysfunction, incontinence and other side effects are almost zero.
- Recovery is shorter. As an outpatient procedure, you’re only given a light anesthetic and you can go home the same day. You can return to work within 3 days, without the catheter.
- Second line treatment options are still available: If focal therapy fails (meaning the cancer continues to grow), you can still undergo surgery or radiation therapy or a repeated focal therapy. On the other hand, if surgery fails (the cancer returns or metastasizes), you can only resort to radiation. If you have radiation and the cancer recurs, you can no longer have surgery and you are usually treated with chemical castration. When surgery or radiation fails, some patients may have focal therapies if scans show a small area of recurrence.
Dr. Walser is only performing the procedure in patients with tumors no larger than 2cm. While he has performed the procedure on larger lesions, the tumor recurs at a higher rate.
To combat the recurrence, the doctor has become more comfortable removing a larger margin of tissue from around the tumor. This margin may contain cancer cells that are not visible on MRI and which can lead to recurrence. There is a challenge with increasing the margin of tissue that is removed – it corresponds to an increase in potential complications like urinary retention.
While taking larger areas decreasing this risk, it has potential complications most commonly seen as urinary retention. When we damage the prostate it becomes inflamed and compresses the urethra making it difficult to urinate. This risk increases with bilateral and larger lesions. We bridge this anticipated side effect with the catheter left in from 1 to several days connected to a leg bag. This is generally the most uncomfortable experience of the entire ablation process and relieved once the catheter is removed.
If you have questions about these criteria or want to learn more, reach out to us.