Focal Prostate Ablation Preserves Erectile and Urinary Functions

A new study suggests that focal laser ablation (FLA) of prostate cancer is associated with low morbidity and helps maintain sexual and urinary function.

Researchers at the University of Texas Medical Branch (UTMB; Galveston, USA) conducted a study in 120 patients (median age 64 years) with low- to intermediate-risk prostate cancer in order to determine if transrectal FLA could preserve sexual and urinary function, while still providing adequate oncologic outcomes. At six and 12 months, all patients underwent clinical and magnetic resonance imaging (MRI) follow-up, with biopsy of suspicious areas. The patients also submitted surveys regarding sexual and urinary function.

The study results revealed that 17% of the patients needed additional prostate cancer treatment after one-year follow-up, with no noticeable change in quality of life or urinary function. In a small group of men who underwent a more aggressive FLA, only 6% had evidence of cancer one year later. However, these men all noticed a significant drop in sperm count. There was no difference between sexual and urinary functional scores before and after FLA. The study was published in the March 2019 issue of the Journal of Vascular and Interventional Radiology.

“FLA pairs MRI imaging to identify cancer-suspicious areas in the prostate and advanced laser technology to remove it completely, with virtually no risk of impotence or incontinence. It offers men more peace of mind than active surveillance or 'watchful waiting', the traditional alternative to radical treatment,” said lead author Eric Walser, MD. “Although FLA doesn't yet have such long-term data, this technique may ultimately provide similar cancer control while better preserving quality of life.”

Current standard of care for men with low-risk prostate cancer is active surveillance, which involves monitoring of prostate-specific antigen (PSA) levels, digital rectal exams, or prostate biopsies. And as radical therapy, which involves surgically removing or irradiating the whole prostate, has significant long-term side effects, including erectile dysfunction and incontinence, it is only used to treat high-risk cancers.

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