Magnetic resonance image-guided focal laser ablation in clinically localized prostate cancer: safety and efficacy

To evaluate the safety and efficacy of focal laser ablation (FLA) in low-intermediate risk prostate cancer.

Inclusion criteria were men aged 50-75 years, prostate-specific antigen (PSA) ≤15 ng/mL, clinical stage T1c-T2a, one or two lesions (PI-RADS ≥3) on magnetic resonance imaging (MRI), and Gleason score 6 (>3 mm) or Gleason 7 on targeted biopsy. Treatment success was defined as no clinically significant cancer in ablated areas. The study is prospective. Under MRI guidance, laser ablation was applied to the visible lesion(s). International Prostate Symptoms Score, Sexual Health Inventory in Men score and PSA levels were assessed at baseline and repeated at 1, 3, 6, 12 and 18 months. MRI was repeated at 3 and 12 months. Cancer control was assessed at 6 months using targeted and systematic biopsies.

FLA was performed in 49 patients. Gleason scores were 3 + 3 in 13 patients (26.5%), 3 + 4 in 29 (59.2%) and 4 + 3 in 7 (14.3%). No significant complications were noticed. International Prostate Symptoms Score measurements up to 18 months were not different from baseline (all P > 0.05). Sexual Health Inventory in Men scores dropped in the first year (all P < 0.05), but were not different from baseline levels at 18 months (P = 0.097). PSA levels dropped significantly at 3-18 months (all P < 0.05). Treatment was successful in 39 patients (79.6%). Persistent cancer in treated areas was found in 10 patients (20.4%).

FLA is safe with no impact on urinary and sexual functions at 18 months follow-up. Oncologic control is encouraging. Larger scale studies and longer follow-up are required.