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New ways to treat BPH

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.

Stay tuned.

Who qualifies for Focal Laser Ablation? What makes a good candidate?

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.

Why should I consider focal therapy?

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.

Why is the tumor size important?

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.

Why have I never heard of Focal Laser Ablation? Why does my urologist tell me to avoid focal therapies?

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.