5-Year Outcomes Following Focal Laser Ablation of Prostate Cancer

To characterize the oncologic outcomes 5 years following focal laser ablation (FLA) of localized prostate cancer.

36 men underwent in-bore FLA of prostate cancer at our institution between 2013 and 2015. Follow up included digital rectal examination and PSA testing, multiparametric MRI, and MR-guided biopsies. The primary outcome of interest was failure-free survival (FFS), defined as avoidance of salvage whole gland treatment, systemic therapy, metastasis, or death from prostate cancer.

Of the 36 men enrolled, 6 were ultimately lost to follow-up. Of the remaining 30, 25 (83%) have remained free from failure over a median follow-up of 71 months'. Among these patients, 10 (40%) developed in-field recurrence, with 9 undergoing salvage partial gland ablation with FLA, cryotherapy, or high-intensity focused ultrasound. Five patients underwent salvage whole gland or systemic treatment and were thus considered to have failed treatment. Two patients developed metastatic disease, and after receiving radiation and ADT, both currently have undetectable PSA levels. No patients in the cohort died from prostate cancer. Limitations include a small study cohort and lack of standardized surveillance protocols 2 years after treatment.

FLA for select cases of prostate cancer provides high rates of FFS, defined as freedom from whole gland or systemic treatment, metastasis, or death from prostate cancer. However, in- or out-of-field recurrence is common and often necessitates salvage ablation.