Two-year Outcomes Following Focal Laser Ablation of Localized Prostate Cancer

Abstract

BackgroundThere is no consensus regarding how to assess oncological control following focal ablation of prostate cancer. ObjectiveTo assess quality of life and in-field recurrence following focal laser ablation (FLA). Design, setting, and participantsOf 34 men participating in a prospective outcomes study following FLA, 32 underwent prostate-specific antigen (PSA) testing and magnetic resonance imaging (MRI) at 6 mo and 2 yr. All underwent assessment of urinary and sexual function at 1 yr. InterventionFLA and MRI-targeted biopsy of the ablation zone. Outcome measurements and statistical analysisThe American Urological Association Symptom Score and the Sexual Health Inventory for Men at baseline and 12 mo were compared using a two-sided Wilcoxon signed-rank test with a significance level of p=0.05. The percentage of positive and negative in-field biopsies was calculated for suspicious and nonsuspicious post-ablation MRI scans. Results and limitationsFLA was associated with no adverse impact on urinary or sexual function. For men with suspicious MRI (MRI+) findings, in-field disease recurrence of intermediate and low risk disease was detected in 75% and 25% of cases, respectively. For men with nonsuspicious MRI (MRI−) findings, in-field disease recurrence of intermediate- and low-risk disease was detected in 22.4% and 50% of cases, respectively. The change in PSA from baseline did not discriminate cases with MRI− findings with and without cancer at 2 yr. ConclusionsMRI reliably identifies in-field recurrence of only intermediate-risk prostate cancer at 2 yr after FLA. A biopsy of the ablation zone must be performed for MRI+ findings. The decision to perform an ablation-zone biopsy for men with MRI− scans should be influenced by whether detection of low-risk disease would influence management. Patient summaryOur study provides compelling evidence that men should undergo interval magnetic resonance imaging to assess the probability of intermediate-risk disease in the ablation zone following focal laser ablation of localized prostate cancer.