Start Interview with and research by Dr Eric Walser University of Texas Medical Branch
Dr Eric Walser is an internationally recognized interventional radiologist with extensive clinical experience of using non-surgical ablation for the treatment of small tumors as an alternative to traditional surgery. Dr Eric Walser uses the TRANBERG® Thermal Therapy System to treat localized prostate cancer in clinical practice.
How do you use MRI-guided laser ablation today to treat prostate cancer?
I use it in low to intermediate-grade prostate cancer when the disease has not spread outside the prostate.
How do you view the potential for this type of treatment of prostate cancer?
As laser ablation is associated with low risk and high precision, I see significant potential for this method of treatment in prostate cancer. Focal therapy and treatment systems such as the TRANBERG® Thermal Therapy System mean that it is possible to measure the temperature around the tumor that is visible by MRI. This is not possible with other treatments and allows accurate targeting of lesions with thermal protection of surrounding structures, such as the urethra, rectum, and nerves/blood vessels.
What benefits does laser ablation have for the patients?
An important benefit for patients is that they can obtain laser ablation treatment without needing to be hospitalized. This obviously means that the disruption to the patient’s day-to-day life is reduced. Other benefits are that few patients experience pain after the procedure, and the incidence of erectile dysfunction is lower for patients who have undergone laser ablation. The general tissue debulking caused by laser ablation also improves urinary function in the majority of men treated in this fashion.
What benefits does laser ablation have over other methods of treatment?
Focal therapy such as laser ablation has few side effects, and the patients experience less pain and blood in the urine, which can be side effects of other treatments. There are other methods, such as high-intensity focused ultrasound, which to a greater degree leads to erectile dysfunction and requires general anesthetic. In addition, these methods take longer to perform than laser ablation.
Dr Walser has published a number of peer-reviewed scientific publication, including the following on focal laser ablation.
MRI-guided Prostate Interventions. Walser E et al. AJR:207, October 2016
In this publication Dr Walser and coauthors discusses use of MRI-guided and MRI directed prostate biopsy techniques, describe how interventional MRI focal therapies are used for the treatment of prostate cancer, and predict future directions in prostate interventional MRI.
The authors conclude that low- or intermediate-risk prostate cancer can be safely treated with MRI-compatible devices and techniques, including focal laser ablation. Although the long-term effectiveness is unknown, the effect on urinary or sexual function is extremely low, which is probably the main reason why these kinds of procedures are attracting an increasing number of men.
The publication is available here: MRI-Guided Prostate Interventions (ajronline.org) .
Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease. Walser E et al. JIVR 2019.
The purpose of this study was to evaluate “if focal laser ablation (FLA) of low to intermediate risk prostate cancer can preserve sexual and urinary function with low morbidity while providing adequate oncologic outcomes”. Concluding the study outcome, the authors state that “One year after FLA, selected patients had low morbidity, no significant changes in quality of life, and 83% freedom of retreatment rate. Sexual and urinary function did not significantly change after FLA.”
The publication is available here: Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease – Journal of Vascular and Interventional Radiology (jvir.org)
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