Related Experiment Video
Updated: Oct 3, 2026
Focal Laser Ablation of Prostate Cancer: An Office Procedure
Published on: March 30, 2021
Safety and functional efficacy of transperineal laser ablation in large prostates (>80 mL): a prospective
Francesco L Conte1,2, Marco Saladino1,2, Luca Lambertini1,2
1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Background:
To evaluate the safety and functional outcomes of transperineal laser ablation (TPLA) in men with large prostates (>80 mL), with specific focus on perioperative events, catheter-related outcomes, and mid-term efficacy.
Methods:
Prospective single-center observational study at a tertiary referral institution. Consecutive patients undergoing TPLA between September 2022 and December 2024 were analyzed; 85 met inclusion criteria (>80 mL). Procedures were outpatient under local anesthesia (± oral benzodiazepines) with transrectal ultrasound guidance. Three-four fibers were used per case (four in 91.8%); median total energy 10,000 J (IQR 9000-12,000), energy density 105 J/mL (IQR 95-125). Follow-up until 36 months with all the patients receiving a follow-up of at least 12 months. Outcomes included IPSS, QoL, MSHQ-EjD, Qmax, PVR; complications were graded by Clavien-Dindo.
Results:
Median age was 67 years; baseline uroflowmetry indicated marked obstruction (Median Qmax 9 mL/s; PVR 120 mL; IPSS 16). Catheter removal failure occurred in 24.7% at day 7 and 7.1% at day 14; 3.5% remained catheter-dependent at 30 days. Overall complications were 22.4%, predominantly grade ≤ II; one intraprostatic abscess (1.2%). No transfusions, sepsis, urethral stricture, de novo erectile or ejaculatory dysfunction were observed; transient mild incontinence occurred in 1.2%. Qmax improved modestly at 3 months (+1 mL/s; P=0.04) and markedly at 6 months (+5 mL/s; P<0.0001), remaining stable thereafter. IPSS decreased significantly through 12-24 months (-10 points; P<0.0001); PVR reduction became significant from 6 months; ejaculatory scores improved; secondary HoLEP was required in 12.9%. Median follow-up was 18 months.
Conclusions:
In prostates >80 mL, TPLA under local anesthesia is feasible and safe, yielding delayed yet substantial improvements in LUTS and flowmetry from 6 months onward, low sphincter-related morbidity, and preserved ejaculation. TPLA may complement enucleation procedures as a volume-adapted, minimally invasive option for selected patients.
