Focal therapy using a novel cooled laser device for prostate cancer: early trial results

To determine the short-term oncological results and safety of the ProFocal Laser Therapy for Prostate Tissue Ablation (PFLT-PC) trial, the first phase II clinical trial of ProFocal® (Medlogical Innovations, Sydney, Australia), a novel, cooled laser focal therapy (cLFT) device for prostate cancer (PCa) treatment.

Men with localised PCa, prostate-specific antigen (PSA) level ≤15 ng/mL, T stage ≤T2c, International Society of Urological Pathology (ISUP) score 2-3 concordant with multiparametric magnetic resonance imaging (mpMRI) visible disease were recruited for this trial (Australian and New Zealand Clinical Trial Registry [ACTRN]12618001774213p) at Nepean Hospital, Australia. The cLFT was performed under general anaesthesia as a day procedure. Primary outcome was adequacy of tissue ablation assessed by mpMRI within 72 h and biopsy at 3 months. Secondary outcomes of functional measures were assessed using validated questionnaires (International Prostate Symptom Score, Sexual Health Inventory for Men [SHIM], Expanded Prostate cancer Index Composite [EPIC], 12-item Short-Form Health Survey). Complications and adverse events within 90 days were reported using Clavien-Dindo classification grading.

A total of 100 patients were recruited. The median (interquartile range [IQR]) age was 66 (60-72) years, PSA level 5.9 (3.9-7.6) ng/mL, prostate volume 39 (30-51) mL and MRI lesion volume 0.84 (0.57-1.2) mL. The median (IQR) treatment time was 60 (47-70) min. In all, 84% had no ISUP Grade Group ≥2 PCa in their 3-month treatment zone biopsies. Erectile dysfunction was reported in 12% of the men, with a 15% mean decline in the SHIM and EPIC-sexual domains scores. There was a 4.5% decrease on EPIC-urinary domain scores. There was no decline in any other functional measures. This study's main limitations were the absence of a control group and the short follow-up.

The PFLT-PC trial demonstrates that at 3 months, cLFT using the ProFocal device provides an 84% treatment success with low morbidity.