Focal laser ablation of select prostate cancer cases may improve outcomes

Some cases of prostate cancer appear to respond well with focal laser ablation (FLA), which boosts failure-free survival (FFS), a study has found.

A total of 36 men with prostate cancer who underwent in-bore FLA participated in the study. These patients were followed for 5 years, and six were ultimately lost to follow-up. The remaining 30 patients completed digital rectal examination and prostate-specific antigen (PSA) testing, multiparametric magnetic resonance imaging (MRI), and MR-guided biopsies.

Over a median follow-up of 71 months, 25 patients (83 percent) have remained free from failure (defined as avoidance of salvage whole gland treatment, systemic therapy, metastasis, or death from prostate cancer).

Of the 25 patients, 10 (40 percent) eventually developed in-field recurrence, with nine undergoing salvage partial gland ablation with FLA, cryotherapy, or high-intensity focused ultrasound. The other five patients considered to have failed treatment underwent salvage whole gland or systemic treatment.

There were two patients who developed metastatic disease, but both achieved undetectable PSA levels following radiation and androgen-deprivation therapy. None of the patients in the cohort died from prostate cancer.

The findings suggest that while FLA provides high rates of FFS for select cases, in- or out-of-field recurrence is common and often requires salvage ablation.

The study was limited by small sample and lack of standardized surveillance protocols 2 years after treatment.