CureTalk on focal laser ablation therapy for prostate cancer

Last Tuesday, through the CureTalks service, we held an hour-long discussion with Dr. Ara Karamanian about the evolving and potential role of focal laser ablation (FLA) in the management of prostate cancer.  The audiorecording of this discussion is now available on line for those who may be interested and who were unable to join us live.

Dr. Karamanian made it very clear that this is a technique that this is still in the early stages of development; it is not covered by Medicare or by the vast majority of commercial health insurance providers; and we have no significant long-term data on the outcomes of men treated using FLA.

In our view, FLA is a technique that may prove to have value in a very carefully selected subset of prostate cancer patients. The question on the table at this time is whether new diagnostic and monitoring techniques (including high quality, multiparametric MRI scanning) can: (a) improve our ability to select the most appropriate patients upfront for such treatment and (b) improve the quality of patient outcomes over time if FLA is carried out “in bore” (i.e., while they are in the MRI scanner) as compared to when FLA is carried out using MRI/TRUS fusion guidance.

Another thing that Dr. Karamanian made clear is that, like almost every other form of treatment for prostate cancer, the skill and the experience of the physician and his support staff in the conduct of FLA is critical to the quality of patient outcomes. In particular, high experience of the treating physician in actually “reading” and interpreting the MRI data and in the use of lasers in focal therapy of abnormalities (in the prostate and/or in other organs such as the kidneys or the liver) is an important prerequisite.

4 Responses

  1. It will be interesting as the diagnosis of prostate cancer and treatment modalities change with technology.

  2. While it is perfectly acceptable for a patient and an insurer to perform any radical surgery they wish in spite of years of varying degrees of success, why do we need to be so cautious on a low- to medium-risk patient given we have new testing modalities such as mpMRI. Why does the “industry” continue to try to hold back progress with this low-risk modality? The mere fact that we have multiple assays being used with significant varying results while still using the same reference range tells all we need to know about the lack of desire on the part of the industry to move forward here.

  3. Is this different or are we talking about the same treatment?

  4. Wolfram:

    This is different. See these two posts from December 20 and December 24 — but do look at them both please. There are problems with the BBC article.

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