V14-04 FOCAL LASER ABLATION OF PROSTATE CANCER: AN OFFICE PROCEDURE

Abstract

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-04 FOCAL LASER ABLATION OF PROSTATE CANCER: AN OFFICE PROCEDURE Wayne Brisbane, Shyam Natarajan, Alan Priester, Ely Felker, Adam Kinnaird, and Leonard Marks Wayne BrisbaneWayne Brisbane More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , Alan PriesterAlan Priester More articles by this author , Ely FelkerEly Felker More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal Laser ablation (FLA) is a promising new treatment for prostate cancer (PCa). FLA has been performed successfully by radiologists inside an MRI. However, in-bore FLA is time-consuming and resource-intensive. This video describes outpatient FLA under local anesthesia in a urology clinic. The procedure is conceptually similar to that of a targeted biopsy. METHODS: Ten patients with unilateral Gleason 7 prostate cancer (PCa) entered a clinical trial of FLA, May-September 2020 (NCT04305925). Using tracked biopsy sites and location of MRI lesions, intended ablation zones were drawn, aiming to encompass the lesion and adjacent positive biopsy sites, while minimizing ablation of benign tissues. Prior to treatment, patients received 1 gram of ertapenem IM, 1000 mg acetaminophen, 30 mg ketorolac IM and optionally, 10 mg of diazepam. Local anesthesia for the prostate was lidocaine/bupivacaine. A laser fiber (Avenda Health) was directed to each intended ablation site using MRI/US fusion (Artemis). An interlocking thermal-optical probe was placed adjacent to the laser for ablation zone monitoring. Temperatures at eight distinct points around the site ablation were displayed in real time on a workstation via the probe. An EPIC-CP questionnaire was completed at baseline and at 3 months after treatment. RESULTS: Ablation was successfully completed on all 10 patients, median age 62 (59 – 69). Six lesions were peripheral, four were transition zone. Treatment time averaged 74 minutes (range 43-90). All patients were conscious and conversant during treatment. One patient required post-procedural foley placement. Otherwise there were no procedure related complications. After FLA, DCE-MRI demonstrated a discrete, non-perfused area, i.e., ablation zone, encompassing the MRI-lesion in all patients (Figure). At 3 months follow-up, EPIC-CP scores were not significantly changed. CONCLUSIONS: Focal laser ablation under local anesthesia is a safe, well-tolerated, and efficient method for ablation of prostate tissue. Near term results are encouraging, and intermediate term results are pending. A version of the FLA system described in the video has received 510k clearance from FDA; efficacy for the treatment of PCa is under investigation. Source of Funding: R01CA218547 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1166-e1166 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wayne Brisbane More articles by this author Shyam Natarajan More articles by this author Alan Priester More articles by this author Ely Felker More articles by this author Adam Kinnaird More articles by this author Leonard Marks More articles by this author Expand All Advertisement Loading ...