Transperineal laser ablation for benign and malignant prostate disease

Purpose: Evaluate the safety and efficacy of transperineal laser ablation (TPLA) of the prostate gland for benign prostatic hyperplasia (BPH) and organ-confined prostate cancer (PCA).

Materials and Methods: 48 male patients with a mean age of 67 had TPLA of the prostate. Twelve had BPH, 19 had BPH and PCA, and 17 had PCA only. Symptomatic BPH is an International Prostate Symptom score (IPSS) of 10 or greater. Prostate cancers were confined to the gland in all 36 patients. A transrectal ultrasound probe guided the transperineal placement of 21g needles into the prostate. The bladder was catheterized and a cannula inserted between the rectum and prostate to infuse saline and protect the urethra and rectum from thermal damage. Laser fibers were advanced through the needles and activated at 3-5 watts for a total of 1800J per ablation (Elesta s.r.l, Florence, Italy). PCA ablations involved the hemigland containing the malignancy. Patients had a follow up prostate MRI to evaluate ablation zones 48 hours after TPLA . Patients had a follow up clinic visit at one week and again at 6 months. SHIM (Sexual Health in Men) scores were calculated before TPLA and 6 months post procedure to evaluate for erectile dysfunction.

Results: All procedures were successful with minor complications of urinary retention requiring catheterization for over one week (15 patients or 31%) and 5 urinary tract infections (UTI-10%). For all patients, the average time of laser irradiation was 16 minutes and all procedures were done in less than one hour. Average energy deposited was 10,440 Joules. The IPSS dropped significantly from 13.6 to 6.9 at 6 months (p=0.001) and the prostate volume reduced from 51.6 cc to 36.8 cc post TPLA (p=0.001). At 6 months, the PSA fell from 10.2 to 4.2 ng/dl (p=0.01). For prostate cancer patients, the gland treatment was smaller so that less laser energy and time occurred (9083 joules and 14 minutes, respectively). SHIM scores did not change significantly. Two of the 36 patients treated for PCA had recurrent cancer detected at 1 and 2.5 years after ablation and were successfully retreated with TPLA.

Conclusion: TPLA is effective and provides significant prostate debulking and and focal cancer ablation. The prostate size and PSA levels decreased significantly at 6 months. More importantly, the BPH symptom reduction was significant with no change in SHIM scores. Most common minor complications were urinary retention and UTI. TPLA is an outpatient procedure lasting less than one hour and requiring no vascular access or radiation exposure and can be repeated as necessary.