MR-Guided Transrectal Focal Laser Ablation for Localized Low- and Intermediate-Risk Prostate Cancer: Initial Outcomes Using an Integrated Laser Ablation System

Abstract

Purpose

To investigate the feasibility and safety of magnetic resonance (MR) imaging–guided focal laser ablation (FLA) in localized, International Society of Urological Pathology (ISUP) Grade 1–3, prostate cancer (PCa) using an integrated system.

Materials and Methods

Ten consecutive males (mean age, 66 years [SD ± 7]) with low-to-intermediate–risk PCa were prospectively included (April 2022–May 2023) and treated with MR imaging–guided FLA using an integrated system for laser energy control and MR thermometry monitoring. Primary end points were technical success, procedure-related adverse events (AEs) following Society of Interventional Radiology (SIR) classification, and 12-month local tumor progression-free survival, defined as no evident residual/recurrent disease on follow-up imaging or histopathology at the treatment site. Secondary end points included MR imaging–derived volumetric tumor coverage percentage, prostate-specific antigen (PSA) levels, and sexual and urinary function response measured by the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) index questionnaires, respectively.

Results

Technical success was achieved in all 10 (100%) patients (ISUP Grade 1, n = 1; Grade 2, n = 8; and Grade 3, n = 1). Three AEs were observed: urinary tract infection (n = 2; SIR Grade 2) and acute urinary retention (n = 1; SIR Grade 3). Cumulative 12-month local tumor progression-free survival was 80% (8/10 patients). Median tumor coverage was 100% (IQR, 95%–100%). Compared with baseline, the mean PSA level decreased, but did not reach statistical significance (6.6 vs 4.4 ng/mL; P = .06), and mean urinary (8.6 vs 7.3; P = 0.60) and sexual function (11.3 vs 10.5; P = 1.00) scores were nonsignificantly altered at 12-month follow-up.

Conclusions

MR imaging–guided FLA in patients with low-to-intermediate–risk PCa using an integrated system was feasible and safe and resulted in promising short-term oncologic and functional outcomes.