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Prostate Laser Focal Therapy

Just curious as I have been reading through several forums and see folks with local contained Pc and are having radical proctectomy. Just wondering why many would consider the radical approach when focal laser ablation is an option with contained Pc? I realize that lesion size and quantity which is usually one lesion is a prime consideration.
thank you
Patrick

  1. In short, because there is much stronger data on the potential of the more radical approaches of being curative.







    Not sure how much research you've done but to some it up as far as my own personal understanding: if you go the radical route, with surgery, it will take typically 1-12 months before you stop leaking urine especially when standing up, walking around and could take 24 months to get your erections back provided they spared both nerves and you had a very experienced robotic surgeon. With average time in the middle of those ranges of course. With radiation, you could have side effects that are delayed a couple years but generally mild. Age and pre-treatment urinary/erectile health plays a big role in ease/speed/completeness of recovery no mater what treatment you select. The big difference is if you do surgery and power through the short-term side effects, you still have radiation as a backup option if the surgery doesn't "get it all" but generally you can't do surgery as a backup if the radiation doesn't "get it all." That's the main reason I personally chose surgery (along with being fairly young.)





    1. Strange some of my response disappeared. Elaborating on the local therapies (laser, hifu, cryo). In most cases, if my recollection is right, insurance won't cover it due to the lack of strong conclusive evidence they are just as effective as surgery or radiation. They could be changing or have changed. My personal opinion is the there is a very narrow subset of PCa patients that should serious consider local therapy. In all honesty, no offence to anyone who has done it, but they represent to me a big gamble in exchange for avoiding the side effects of the more radical treatments with stronger data.

  2. Hi . Just to follow up a little on what was saying, I found this study which found focal ablation to be effective, but it only is looking out one year from the initial treatment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503805/. Also, when I say it was found effective it is important to note that the study only looked at Gleason 6 and 7. The authors note that when comparing to the prostatectomy recurrence rate there are issues in that the surgery includes higher Gleason scores and goes out five years. These are not small differences - it's apples and oranges. That said, every treatment starts somewhere and it simply takes time for the body of evidence to build. I did find one study looking at five year outcomes, primarily failure-free survival (FFA), but it only had 30 patients followed to the end: https://pubmed.ncbi.nlm.nih.gov/34090887/. It concluded that "FLA for select cases of prostate cancer provides high rates of FFS, defined as freedom from whole gland or systemic treatment, metastasis, or death from prostate cancer. However, in- or out-of-field recurrence is common and often necessitates salvage ablation." Right now focal ablation seems that it could be a viable option for those with low grade, slow growing PCa - perhaps as an alternative to active surveillance. It may often be putting off more extensive, invasive treatments, but for many that may be just fine. Best, Richard (ProstateCancer.net Team)

    1. After my diagnosis of PCa in 2014, I chose FLA as my treatment option. The possible outcomes long term were far better than surgery or radiation. I was 1 3+4 and 1 4+3 with a PSA of 5.4. The 4+3 was ablated. I had no side effects. I left on a cruise the next day. Seven years later, the second lesion became a problem and I had it ablated.


      The big difference is that FLA is not a whole gland treatment but one that treats lesions as they occur. It's not for everyone. But it was what I considered my best choice.


      The other downside was paying for the treatment. I paid for the first one out of pocket. The second was covered but I'm not sure how. It just was.


      If it means that I have to have an ablation every 7 or 8 years, I can handle that. The procedure is pretty simple. At this point, I'm 77. I'm not much worried about the future any more.

      1. We all make the decisions we are comfortable with - Glad it is working for you. I have you beat by 2 years and also suspect the future may not be a long term worry. No matter how you look at it --- you just do not know what the future holds for any of us

    2. Amen!

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