Wednesday, December 17, 2014

UCLA Completes Safety Trial for MR guided Focal Laser Ablation of Prostate Cancer

Sagittal view of the laser during MR guided ablation.
Today, study co-investigators Drs Leonard Marks (Professor of Urology) and Steve Raman (Professor of Radiology) at Ronald-Reagan UCLA Medical Center in Los Angeles completed a  trail of a nine patients to evaluate the safety of MR guided focal laser ablation of low risk prostate cancer. What an exciting time!

MR guided Prostate Laser Ablation:
Axial view of the laser fiber during MR guided ablation.
The system used was Metronic MR guided endorectal system. The original application of this system was designated for transrectal MR guided biopsy of suspicious prostate lesion; but through efforts of clinically minded people, the system was adapted to accommodate laser ablation. The system has been used by several groups in the country including University of Chicago and Desert Imaging in Palm Springs, California.

Post-treatment contrast-enhaced MR.
 The ablated tumor is non-enhancing (black). 
Advantage: The primary advantage of this system over other focal therapy option is the MR guidance. Prostate is a very heterogenous organ and MR is the only imaging modality which can characterize prostate cancer accurately. Having the capability of MR guidance allows for pin point accuracy of the laser fiber placement at the target and MR allows internationalists to monitor tissue ablation using MR thermometry. MR thermometry reflects the temperature changes of the ablated tissue and thus, interventionalists can confidently feel reassured that the tissue teach the temperature needed for coagulative necrosis. More importantly, interventionalists can visualized the neurovascular bundle and avoid these sensitive structures to preserve potency. However, it's too early to conclude on functional or oncologic outcomes.

The main disadvantage is  time; the ablation can take anywhere from 2-3 hours. In comparison, radiation therapy or surgery may take less time depending on the operator. However, in contrast to surgery, patients do not have to undergo general anesthesia. Also, in contrast to radiation oncology, MR guidance allows for avoidance of neurovascular bundles and other sensitive sensitive surrounding structures.

Current indication:
The trial was for safety purpose only and has completed as of today. We do not yet know the oncologic outcomes. The study enrolled patients who were low to intermediate risk only based on targeted biopsy data and PSA.

Future direction:
The collected data will be analyzed to help refine the current approach, so stay tuned!

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