Nepean and Macquarie Urology Centres
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Focal Laser Therapy

Macquarie University - Non invasive surgery

Frequently asked questions about Focal LASER Therapy for prostate cancer.

  1. Prostate Cancer Unique Clinical Conundrum
  2. What is focal LASER therapy? Is it feasible?
  3. Impact of multiparametric MRI on Prostate Cancer Diagnosis
  4. MRI Guided Focal LASER Ablation of Prostate Cancer
  5. Who is a Candidate for Focal Laser Ablation of the Prostate?
  6. What to Expect: Short Term
  7. Will My Cancer Be Cured?
  8. What Surveillance is necessary after my Focal LASER Ablation
  9. Why A/Professor Varol and Macquarie Medical Imaging?
  10. How to Determine If Focal Laser Ablation is a possibility for you?

Prostate Cancer: A Unique Clinical Conundrum

There is no other cancer where a non-specific tumor marker like PSA triggers a random biopsy of the prostate. In many of these cases the cancer is missed or an insignificant Prostate cancer is detected. More commonly treatment is initiated when it may not have been necessary. What is needed is a way to image the prostate and reliably assess the site and extent of disease.

What is focal LASER therapy? Is it feasible for prostate cancer?

Men who have prostate cancer confined to one small area of the prostate may wish to consider focal LASER therapy (also known as partial gland therapy or prostate (lumpectomy). The goal of focal LASER therapy is to ablate only the small area of the prostate that is cancerous, rather than removing or ablating the entire gland. The rationale for focal therapy is based on the observation that low-risk prostate cancer is sometimes ‘over-treated’, in the sense that some of these cancers are unlikely to cause harm. In these cases, a less invasive procedure will cause fewer unnecessary complications. There are, however, many small cancers that threaten the well-being of younger men. The aim of focal LASER therapy is to destroy all of the biologically active cancer while eliminating the risk of side effects that are associated with surgery or radiotherapy.

In Australia - focal LASER therapy is now feasible at Macquarie University. Associate Professor Celi Varol has taken the lead in defining the role of focal LASER therapy in the treatment of prostate cancer.

Impact of multiparametric MRI on Prostate Cancer Diagnosis

Up until very recently, focal LASER therapy was not feasible since we did not have a target to ablate. Prostate cancer was diagnosed by randomly obtaining prostate tissue cores under ultrasound guidance. Unfortunately, prostate cancer can NOT be identified by ultrasound. A routine MRI is just as unreliable as ultrasound for detection prostate cancer. Advances inmultiparametric MRI (mpMRI) imaging have revolutionised the treatment of prostate cancer. Macquarie University and Macquarie Medical Imaging are the leaders in the field of mpMRI imaging of the prostate. We have demonstrated in our research that when the mpMRI of the prostate shows no abnormality there rarely exists significant prostate cancer. Whereas if there are abnormalities demonstrated on the mpMRI scan than these are highly suspicious for cancer. The positive predictive value for biopsy proven cancer is extremely high. We have so much confidence in our mpMRI scans that at Macquarie University, we rarely perform a random prostate biopsy without obtaining an mpMRI. A large proportion of prostate cancers are being detected on the basis of mpMRI and therefore we now also have the ability to diagnose and a target to ablate any cancer lesions.

MRI Guided Focal Ablation of Prostate Cancer

Technique Over the past several years, Dr Celi Varol, Associate Professor and Chair of the Department of Urology at Macquarie University together with Macquarie Medical Imaging has pioneered a technique for focally ablating prostate cancer under MRI guidance. He has the largest experience with laser ablation of prostate cancer in the Australia and increasingly in the world.
The prostate is anesthetized with local anesthesia just as is done prior to a prostate biopsy. The technique is performed under sedation with local anesthesia inside the MRI machine. The region of interest harboring the prostate cancer is identified and a laser fiber is introduced directly into the prostate cancer under MRI guidance. MRI is highly temperature sensitive. Therefore, the temperature of the critical structures adjacent to the prostate including the rectum, urinary sphincter, and erectile nerves are monitored in real time so it is extremely rare to have any collateral damage to these structures. The temperature of the ablation site within the region of interest known to have prostate cancer is also monitored in real time to optimise destruction of the indexed lesion of the Prostate cancer. At the completion of the procedure, contrast is administered to show that the region of interest has been successfully ablated.

Who is a Candidate for Focal Laser Ablation of the Prostate?

A/Professor Celi Varol is currently undertaking the first University and Ethics board approved trial for Focal Laser Therapy for patients with Prostate Cancer in Australia. This trial has also been registered with the Government arm of Medical Devices and Trials Therapeutics Goods Administration (TGA)

First, the candidate must have a region of interest that can be seen and localised to the prostate on a mpMRI. Ideally, the mpMRI is obtained prior to a prostate biopsy. If the site of the cancer in the biopsy tissue cores and the region of interest on mpMRI are aligned, this is adequate evidence that the mpMRI region of interest reflects prostate cancer. A/Professor Varol was one of the first Urologists in Australia to use the MRI targeted biopsy system.

The ideal candidate for this procedure is an individual who has a high priority to preserve continence and sexual function. Ideally, there is a single prostate region of interest on the mpMRI that is confirmed by biopsy to be a low or intermediate risk prostate cancer.

What to Expect: Short Term

The immediate post-procedure recovery is truly simple. As soon as the procedure is completed, you walk out of the MRI. You will be discharged about one hour after the procedure. The evening of the procedure you may engage in unlimited activities. Some men have chosen to have intercourse within the first three days after the procedure.

Will My Cancer Be Cured?

We do not have long-term data using this technique. We believe all the disease in the region of interest will be destroyed. Based on the MRI it is unlikely you have significant disease elsewhere in the prostate. While more than likely there is prostate cancer in the non-ablated area, because of the negative mpMRI and biopsy in these areas, we do not feel an immediate need to treat beyond the region of interest. While we cannot make guarantees that all the cancer is gone and you will not develop disease progression, we believe that with careful follow up any residual disease, if it exists, will not escape our surveillance. The trade off for the requirement for future surveillance and possible re-treatment is essentially full preservation of continence and sexual function.

What surveillance is required after my Focal Laser Ablation

At the present time our surveillance protocol requires a digital rectal examination (DRE), serum PSA and mpMRI guided targeted biopsy 6 months of the ablation. If all these tests do not indicate residual disease, these tests will be repeated at one year. The mpMRI will be performed bi-annually. Subsequent biopsies will be performed based as the results of these surveillance tests.

Why A/Professor Varol and Macquarie Medical Imaging?

A/Professor Varol has been performing Laser Prostate Surgery since 2002. His interest has been Robotic and Minimally invasive treatments for both Prostate Cancer and benign Prostate Disease. He is leading research on prostate cancer imaging and diagnosis with the latest MRI machine at Macquarie Medical Imaging. He has been a pioneer in Minimally Invasive Prostate and Bladder cancer surgery in Australia, having performed over 1000 Robotic and Laparoscopic operations. It puts him in an ideal position to explain the pros and cons of focal ablation relative to other treatment options. A/Professor Varol will discourage you from LASER ablation therapy if it is not a reasonable option.

How to Determine if Laser Prostate Cancer Ablation is a possibility for you?

In order to arrange a consultation,

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