Prostate Cancer Treatment

Laser Focal Therapy -
Prostate Cancer Treatment

We use Laser Focal Therapy (focal laser ablation) for the treatment of low-to-intermediate prostate cancer. Laser focal therapy can also be used to help improve the symptoms associated with benign prostatic hyperplasia (BPH). 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 ablate, or kill, cancer cells. The temperature and the extent of the ablation zone are constantly monitored and maintained with MR imaging, allowing HALO Dx clinicians to determine if all visible tumors have been destroyed.

Advantages

of Laser Focal Therapy (Focal Laser Ablation) for Prostate Cancer

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MINIMALLY INVASIVE

Minimally invasive, ambulatory outpatient procedure - usually a 4 hour procedure.

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RAPID RECOVERY

Most patients can return to work the next day.*

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NO ANESTHESIA

No general anesthesia required.

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IMPROVED URINATION

Vast majority of men have improved urination after the procedure.*

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LOWER RISK OF SIDE EFFECTS

Lower risk of side effects such as urinary incontinence, impotence and decreased bowel function compared to surgery or radiation therapy.

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IMPROVED ACCURACY

Better accuracy compared with other focal approaches, e.g. High-Intensity Focused Ultrasound (HIFU).

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NO LIMITATIONS

Unlike other treatments, focal laser therapy does not limit the option to treat with radiation therapy or surgery if needed later.

Radical Prostatectomy and Other Traditional Procedures Can Have Severe & Permanent 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 Diagnostics

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 to treat prostate cancer. 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. 200 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 10% erectile dysfunction, and less than 3% 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.

How Does Laser Focal Therapy Compare to Other Focal Methods?

In comparison to another popular focal treatment methods like high-intensity focused ultrasound (HIFU), laser focal therapy is not limited to only small glands and has demonstrated much higher levels of accuracy with lower risk of side effects such as, erectile dysfunction.  

High-intensity focused ultrasound (HIFU) uses ultrasound instead of laser to heat the tissue. To obtain the ablation diameter (area of cancerous tissue being killed) of the laser used in our approach, HIFU would require more than 20 overlapping ablations. What if the patient moves a little and the device misses a spot? When treating cancer, it’s important to get all of it. The vast majority of HIFU centers use ultrasound guidance (instead of MRI), losing the precision of MRI and the important real-time information that MRI thermometry (temperature measurement) provides in protecting vital structures. Studies show significant urinary and sexual problems after HIFU because important tissues and nerves can be damaged during the procedure.

Laser focal therapy boasts many benefits for patients compared to other treatment methods for prostate cancer. No general anesthesia is required for the therapy, and patients are able to return to work as early as the day after the operation. Additionally, laser focal therapy carries lower risk of side effects compared to other treatment methods such as erectile dysfunction (impotence), and urinary incontinence. Laser focal therapy also does not rule out the exploration of further treatment options such as surgery or radiation therapy if needed later. 

When deciding which type of prostate cancer treatment to choose, it is important to consider how each treatment differs and how this may impact the treatment results.

*Results may vary

   

Low -risk prostate cancer

Biopsy grade group 1

Biopsy Gleason score <=6

Medium-favorable-risk prostate cancer

Biopsy grade group 2

Biopsy Gleason score 3+4=7

Medium-unfavorable-risk prostate cancer

Biopsy grade group 3

Biopsy Gleason score 4+3=7

High-risk prostate cancer

Biopsy grade group 4+

Biopsy Gleason score 8+

No treatment Active surveillance X ( X )    

Focal (localized) therapy

Laser Focal Therapy   X X ( X )
HIFU   X X ( X )
Cryotherapy   X X ( X )
Whole gland therapy Radical Prostatectomy     ( X ) X
Radiation (internal / external)     ( X ) X

 

    Pros Cons
Focal (localized) therapy Laser Focal Therapy
  • <1% risk of erective dysfunction (vs 50% whole gland therapy
  • <1% risk of incontinence (vs 25% with whole gland therapy)
  • <1% risk of infection (vs 4% with whole gland therapy)
  • Ambulatory outpatient procedure lasting 4 hours only
  • Rapid recovery: most patients can return to work next day
  • No general anesthesia required
  • Highly accurate (within 1 milimeter)
  • Does not limit the option to treat with radiation therapy or surgery if needed later
  • Not covered by insurance or Medicare
HIFU
  • Minimally invasive, outpatient procedure
  • No general anesthesia
  • Less precise than Laser Focal Therapy (margin or error is 3-5 millimeter, which is significant given the prostate is surrounded by nerves)
  • Higher risk of side effects vs Laser Focal Therapy
  • Not covered by insurance and Medicare
  • Requires patient wear a catheter for ~3 weeks
  • Limited long term survival data / Less precise
Cryotherapy
  • A good option for patients with large tumors or small central tumors
  • Covered by insurance and Medicare
  • More invasive and less precise than Focal Laser Therapy
  • Requires general anesthesia
  • Requires general anesthesia

 

*This content is solely for informational purposes and does not substitute for medical advice. Speak with your doctor or contact us if you have personal or medical questions.

Laser Focal Therapy: What to Expect

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. 

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.

There Is a Better Way

Featured Patient Testimonial: Wayne Gregory

Family, safety, and preserving quality of life were top of mind for Wayne Gregory when he chose laser focal therapy, also known as focal laser ablation (FLA), to treat his prostate cancer.

“I had lesions ultimately on both sides of the prostate near the nerve bundles," said Gregory. "I knew that the skill and precision it was going to take to get that cancer ablated was going to have to be very, very high.”

He shared his story while on a trip back to Houston, Texas, where he had the procedure performed by Dr. Ara Karamanian, Director of HALO Diagnostic's Prostate Program and Medical Director of the Prostate Laser Center.

Featured Patient Testimonial: Tom’s Story

“I just felt like the technology and the skill level of HALO Dx was light years ahead of what was here available to me locally and that's why I made the choice to go down there. It just seems like a rational, logical alternative that you don't have to be a doctor to be able to appreciate."

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