Laser Focal Therapy for Prostate Cancer
A new path forward in prostate cancer treatment
The HALO Dx Approach
At HALO Dx we use Laser Focal Therapy (laser ablation) for the treatment of prostate cancer. This procedure involves placing the patient inside the MRI scanner and displaying MRI images and thermal maps on a computer screen. A thin laser fiber is guided to the tumor and laser energy is applied to kill the cancer cells. The temperature and the extent of the ablation zone are constantly monitored with MRI imaging, allowing HALO Dx to identify if all visible tumors have been destroyed and monitor that no important structures are damaged.
Laser Focal Therapy has many advantages:
- Minimally invasive, ambulatory outpatient procedure (usually lasts 4 hours and patient can go home after)
- Rapid recovery: most patients can return to work the next day*
- No general anesthesia required
- Vast majority of men have improved urination after the procedure*
- Lower risk of side effects such as urinary incontinence, impotence and decreased bowel function compared to surgery or radiation therapy
- Better accuracy compared with other focal approaches, e.g. High-Intensity Focused Ultrasound (HIFU)
- Unlike other treatments, focal laser therapy does not limit the option to treat with radiation therapy or surgery if needed later
Traditional approaches like radical prostatectomy (RP) have severe side effects:
- 50% risk of erectile dysfunction (impotence)
- 25% risk or urinary incontinence
- Dry orgasm
- 20-40% cancer recurrence within 10 years, 30-50% cancer recurrence during patient’s lifetime
Laser Focal Therapy - Invented by HALO!
In 2010, the team of Bernadette Greenwood, Chief Research Officer at Halo Diagnostics, and Roger McNichols, PhD, developed the system to perform Laser Focal Therapy. The first case in the world was performed by the HALO Diagnostics team of Dr. John Feller, Ms. Greenwood, and Dr. McNichols in 2010.
HALO Diagnostics released interim 10-year results from its Phase II 20-year clinical trial for prostate laser focal therapy in patients with localized prostate cancer. Over 170 men, 45-years or older diagnosed with low-to-intermediate risk or recurrent prostate cancer, volunteered to participate in the study. The results are impressive: less than 1% infection, less than 1% erectile dysfunction and less than 1% incontinence – compared to conventional whole gland prostatectomy which has a risk of up to 50% erectile dysfunction and 25% urinary incontinence. These results, along with a 100% prostate cancer-specific survival rate, are an encouraging development for men looking for a prostate cancer therapy option with a lower risk of side effects.
*Results may vary
Laser Focal Therapy: What to Expect
A detailed outline of your patient journey
You will receive both email and phone contact information for our medical team so that you can always reach us. In addition, we conduct a pre-operative consultation prior to the procedure, we meet the day of the procedure, and will see you frequently in follow-up.
Our team will have collected and reviewed your medical records to evaluate you for inclusion and suitability. Our surgical team will have discussed your case during Tumor Board and conducted a surgical plan based on size, number, shape and location of ablation areas. Prior to the procedure, we will review the Informed Consent Document with you to ensure you understand every aspect of the procedure. We will discuss the risk, benefits, and paperwork of the procedure.
The day of the procedure, our nurse will place an intravenous catheter (IV) in your arm so that she/he can administer IV antibiotics, pain medications and fluids (to maintain hydration). Should other medications be necessary, they will be administered through this IV as well. Lidocaine jelly will be inserted in the rectum to decrease sensation. A numbing medicine will be injected into the prostate and conscious sedation will be performed using fentanyl and versed medications under physician direction and monitoring.
You may have a urinary catheter placed so that we can provide cooled urethral saline through Continuous Bladder Irrigation (CBI) protection. This catheter remains in place depending on the size, shape, and location of treatment. Our urologist will perform the insertion and removal.
Patients are positioned on their stomach on the MRI table for the procedure. A small rectal probe (the diameter of an index finger in width) covered in numbing lidocaine jelly to allow access to the prostate. We use the transrectal route for laser fiber placement. This is minimally invasive (compared to thermocouples and transperineal needles), with fewer complications and less recurrence. Technical errors due to misregistration are also less frequent with transrectal fiber placement under MRI guidance.
During the procedure, we will use real-time MRI to visualize the target, guide placement of the laser fiber, and ablate (destroy) cancer cells or for either cancer or BPH (an overgrown transitional zone) while protecting healthy tissue with “safety markers” that are positioned at the urethra and neurovascular bundle. This helps monitor sensitive structures to decrease risk of damage to urinary and sexual function.
Patients will return home or to their hotel room after at least two hours in the recovery room that same day. They must be accompanied by a family member or care giver as driving is not permitted.
We see each patient again according to our rigorous follow-up protocol. This includes follow-up imaging, biopsy and PSA monitoring.
At HALO Dx we are mindful of the patient experience and acceptance of the technology. We do not offer endorectal coil for MRI for the same reasons, instead, we offer a high channel-count phased array pelvic coil. This surface coil is used for both diagnostic prostate imaging and allows access to biopsy and therapy.
- Pre-procedure MRI confirms the location and boundaries of the target(s).
- The DynaTRIM device is calibrated to the images, and the parameters (knobs) are adjusted to an appropriate three-dimensional approach.
- The thin, 1.85mm cooling cannula and FDA cleared laser fiber is then placed into the target through the inner channel of the rectal probe under MRI guidance. Continuous bladder irrigation (CBI) may be performed. The laser is then applied at low power “test dose” to confirm appropriate location with the heat from the laser being monitored with real time MRI thermometry in two separate planes. Only after this final confirmation, the team will increase the laser to treatment level power, monitor the tissue being ablated and make appropriate adjustments to contour the ablation zone.
- The laser fiber is usually then repositioned multiple times to provide overlapping ablations. Because we believe in obtaining wide margins, we will usually perform many overlapping ablations.
- At the end of the treatment, we evaluate the result with contrast enhanced MR imaging.