There are a narrow set of patients who are good candidates for Focal Laser Ablation. When properly selected, Focal Laser Ablation produces the results that patients want without the side effects of surgery and radiation.
Take a look at this list – do you share any of these characteristics? You don’t need to share all of them to be a good candidate.
- Age: You are older than 65
- Family History: You have no family history of prostate cancer (your father and brothers have not died from the prostate cancer)
- Race: You are not African American
- Gleason Score: Your score is low at 3+3, 3+4, 4+3.
- Tumor Location: Your tumor is confined to the prostate gland (meaning it has not metastasized). There is no seminal vesical involvement.
- Tumor Size: Your tumor is no larger than 2cm
- PSA Levels: Your most recent Prostate Specific Antigen test results are between 4 and 10
- Symptoms: Sudden urge to urinate, waking up to urinate, weak stream
- Recovery Time: You want to return to work within the week.
- Risk Tolerance: You have a low risk tolerance for side effects and do not want urinary or sexual function impacted
If you think you might be eligible for focal therapies, please reach out and ask.
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.
Focal therapy for the prostate began in the late 1990s; however, there is a very limited number of providers who are trained and skilled enough to perform this procedure. These 5 doctors have the most experience and have performed over 100 Focal Laser Ablation procedures:
Wavelength Medical has 1-2 years of data on the recurrence rate of cancer after focal therapies and needs an additional 3-5 years to obtain approval from insurance companies to pay for the procedure.
As most urologists do not perform and are not familiar with this procedure, they do not recommend it. Typically trained as surgeons, their preferred therapies for prostate cancer are watchful waiting or removal/ radical surgery. Focal therapy is an option in between those extremes; you might be a candidate. Check this out to learn more to see if you qualify.
There aren’t any research studies that provide a definitive answer. We think it is the Focal Laser Ablation procedure. During the FLA, we constantly monitor all of the sensitive structures (nearby areas that can be damaged with slight changes in temperature), including:
- Temperature of the prostate
- Temperature the nerve bundles
- Temperature of the urethra
- Temperature of the rectum
This ensures that the tumor is precisely ablated without damage to the other sensitive structures. As a side note: FLA was initially invented to treat small brain tumors because of its precision and safety.
Cryotherapy is also safe and effective but less precise which makes it ideal for larger tumors. It has been around the longest and, fortunately, the risk of recurrent cancer after cryotherapy is similar to that of surgery. While Wavelength Medical focuses on FLA, we are also experts in cryo-therapies within the MRI environment. Reach out to us and we can find the right treatment for your tumor. Cryotherapy requires an overnight stay in the hospital while FLA is done as an outpatient.
Dr. Walser actively conducts research and monitors his patients for years after the procedure. If you choose to work with Wavelength Medical, we will also monitor you so that the outcomes of your procedure can help improve the care for other men. Dr. Walser has documented his findings and submitted articles for peer-review journals outlining all these data. Those articles will be made available soon. Since 2011, the Wavelength Medical team has performed over 300 procedures and we have been closely tracking the outcomes and recovery (at least 1 year post-treatment) for about 200 patients. The major side effects and their risks are:
- Infection: 1-2%
- Erectile Dysfunction: <5%
- Urinary Incontinence: essentially 0%
- Recurrence: 10-15% of patients undergo a second FLA procedure 1-2 years after the initial procedure. Fewer than 5% of patients choose to return for a third ablation procedure
Notes: Similar rates of re-treatment are seen in prostatectomy (prostate surgery) patients. And we are actively working to decrease those rates of retreatment. Data reflects patients treated from 2011 through 2017.
To all of you interested in focal therapy for prostate cancer, a new series of 120 patients followed after FLA at UTMB in Texas has been published in the Journal of Vascular and Interventional Radiology (JVIR). Here is a link that will be active for the next 50 days. Send us an email if you need a PDF of this article sent to you.
A new FDA approved hydrogel is injected between the prostate and rectum to reduce rectal injury and improve quality of life in prostate cancer patients undergoing radiation therapy or proton beam treatments.
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.