Abstract
Background: To evaluate the safety and efficacy of focal laser ablation (FLA) in lowintermediate
risk prostate cancer.
Methods: Inclusion criteria were men aged 50–75 years, prostate-specific antigen (PSA)
≤15 ng/mL, clinical stage T1c–T2a, one or two lesions (PI-RADS ≥3) on magnetic resonance
imaging (MRI), and Gleason score 6 (>3 mm) or Gleason 7 on targeted biopsy. Treatment
success was defined as no clinically significant cancer in ablated areas. The study is prospective.
Under MRI guidance, laser ablation was applied to the visible lesion(s). International
Prostate Symptoms Score, Sexual Health Inventory in Men score and PSA levels were
assessed at baseline and repeated at 1, 3, 6, 12 and 18 months. MRI was repeated at 3 and
12 months. Cancer control was assessed at 6 months using targeted and systematic biopsies.
Results: FLA was performed in 49 patients. Gleason scores were 3 + 3 in 13 patients (26.5%),
3 + 4 in 29 (59.2%) and 4 + 3 in 7 (14.3%). No significant complications were noticed. International
Prostate Symptoms Score measurements up to 18 months were not different from baseline
(all P > 0.05). Sexual Health Inventory in Men scores dropped in the first year (all P < 0.05),
but were not different from baseline levels at 18 months (P = 0.097). PSA levels dropped significantly
at 3–18 months (all P < 0.05). Treatment was successful in 39 patients (79.6%). Persistent
cancer in treated areas was found in 10 patients (20.4%).
Conclusions: FLA is safe with no impact on urinary and sexual functions at 18 months followup.
Oncologic control is encouraging. Larger scale studies and longer follow-up are required.
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2019
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