MRI-guided, targeted laser prostate cancer surgery …

… is not going to be “coming soon to a urologist’s office near you” … but it has now been carried out on a thoroughly well-informed physician-patient at the University of Colorado.

The first such procedure was apparently carried out at the end of September by Dr. Al Barqawi, according to the October 27 issue of UCH Insider (which is not yet available on the UCH Insider archives on the university’s web site).

Information on the patient’s PSA, clinical stage, and Gleason score was not provided in the article in UCH Insider. However, the available information suggests that the 66-year-old physician-patient had relatively low-risk, localized prostate cancer (identified as “a pair of sand-grain-size tumors”) in one lobe of the prostate. The tumors had been identified and isolated using three-dimensional mapping biopsy, and the objective of the operation was to treat exclusively the tumors themselves, without impacting any surrounding tissue unnecessarily.

The actual process of laser treatment took approximately 90 seconds. However, the total operation lasted for 5 hours because of the complexity of identifying and imaging the two tumors using MRI, introduction of the laser probes, then moving the patient back into the MRI and positioning him for the actual procedure.

The process of targeted laser surgery ought to be able to minimize the side effects of localized prostate cancer treatment compared to any other available method because of the accuracy with which laser energy can be focused on specific areas of tissue (as compared to the relatively wide areas that must be treated using radiation therapy or cryotherapy or HIFU). However, the fly in the ointment is the accuracy with which the physician can identify the actual areas of tumor that need to be treated, and the confidence that can be placed in whether all relevant tumors have been effectively treated.

Dr. Barqawi has stated that “the laser technique’s precision exceeded his expectations.” However, a great deal of work remains before it will be possible to look at this type of laser surgery as having potential as a routine process for the treatment of localized prostate cancer.

From the patient’s point of view, the procedure was apparently a great success. He clearly appreciated that, “Being the first to undergo the procedure would involve trade-offs.” However, he also said that, “I had the procedure on a Friday and was able to work a full day on Monday, with the only problems related to the time of healing of the irritation from the catheter.”

Dr. Barqawi was assisted in carrying out this procedure by two radiologists — Drs Dodd and Patel — from the University of Colorado. Obviously this is a complex procedure requiring close cooperation between the surgeon and the MRI specialists who must be able to accurately identify and image the tumors for the procedure to be carried out at all.

At the end of the day, one has to ask (as usual) whether this patient really needed to be treated at all, or whether he was a perfectly valid candidate for some form of expectant management (e.g., active surveillance). However, while we are still in a mindset for many patients that “I just want the cancer out,” the further development of laser-targeted prostate cancer would seem to be justifiable — if the early results continue to show promise.

9 Responses

  1. Doesn’t Barqawi head up the focal cryotherapy program at UC as well? Seems like an experimental playground for treating indolent cancer …

  2. Seems backwards. I would think that those with life threatening cancers should have the first access to experimental treatments.

  3. I’m not sure I would go quite that far. One way to look at this is that the best way to learn a technique like this is to start on patients who are at limited risk and then see if you can “work your way up” to being able to do it on those who would benefit most (presumably men with a small focus of Gleason 8-10 disease in one lobe).

  4. That would be true when you have some degree of comfort that they are at least as effective as currently available treatments. However, if I was diagnosed tomorrow with Gleason 9 localized prostate cancer, I don’t think I would be ready (yet) to forgo the known potential of an RP carried out by an acknowledged specialist in minimally invasive surgery to try laser-guided surgery. Maybe when Dr. B. has done a couple of dozen and has some follow-up data … but not yet! Others may be willing to take such a risk now, of course — and good luck to them.

  5. I agree. Any patient willing to be in the first group to try these things is braver than I am. And Barqawi is obviously attracted to being the first to perform such things.

  6. PCa tumors are not thought to be SUDDEN, single eruptions, that appear one day but did not exist the day before. All indications are that they are slowly progressing clusters of cells, gradually turning from their benign state that encourages natural apoptosis cycles, into resistant malignancies made up of “out of control” cells that continue to multiply.

    Assuming this is the case, and considering the acknowledged limitations of current technology to identify very early occurring cellular changes (micro) and the multi-focal tendencies of the disease, what gives us any confidence that such focal treatment will ELIMINATE PCa? This is particularly true when one considers that approximately 20 to 30 percent of radical prostatectomy and radiation patients, EVENTUALLY, recur.

    It should be understood by newly diagnosed patients, that “focal” treatment, of any kind, has yet to prove itself in long range results and must be considered highly “experimental.” Providing that is clearly understood and the patient accepts the obvious risks inherent in such experiments, then he has the right to involve himself in such a “trial,” whether others think it is wise or not.

    When there are alternatives available, with known statistical findings exhibiting high rates of success, I guess I would tend to take the known over the unknown. If the rates of success were unusually low, as in SOME more advanced PCa cases, I would likely be far more eager to ride the investigational wave, and to do so with optimism. – (aka) az4peaks

  7. If and when imaging techniques are developed to reliably detect small prostate cancers, this technique could be used to treat them nearly as easily as small skin cancers that are removed when detected. Death from prostate cancer would become a thing of the past, or at least extremely rare.

    Unlike so much of the research we see published on this board, this is a step in right direction toward ending prostate cancer death in our time, and without the side effects so common to current main stream treatment methods.

  8. My biopsy showed very small rice grain tumor in one area of my prostate. I am looking for the right treatment for my specific condition and need advice and guidance. Please contact me either by phone or email. Thank you.

  9. Brian:

    We do not offer phone or e-mail consultation. However, if you join our social network we can certainly help you to understand the most appropriate options available to you for treatment … if treatment is even necessary at all.

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