AUA 2018: Two Year Oncological Outcomes Following Focal Laser Ablation

San Francisco, CA ( Brian Chao and Dr. Lepor presented the NYU experience using focal laser ablation (FLA) now that they have 2 years’ worth of oncologic data and 1 year of functional outcomes data. They recruited 34 men undergoing in-bore FLA with clinically localized disease, PSA <10, Gleason <8, and MRI findings demonstrating index lesions.

Functionally, there was no significant change from baseline in standardized measurements for erectile function and lower urinary tract function. The AUA symptom score, SHIM erectile function score, incontinence pad number, and self-reported incontinence rates were all the same at 12 months as at baseline prior to FLA.

Previous 6-month data by this group did not give concern for oncologic failures following FLA. At 2 years, 8 men with positive MRI findings were found to have cancer in the ablation zone. The NPV of a negative MRI (24 men) was 78%, but the PPV with a positive MRI was high enough to demand a reflex biopsy in these men to evaluate for clinically significant residual cancer. Over half of men with pre-treatment intermediate-risk disease had cancer remaining in the ablation zone at 2 years, indicating that the treatment zones need to be improved. In summary, MRI use after FLA appears to be a very useful tool for evaluating oncological metrics.

The authors conclude that although FLA has excellent functional outcomes, but caution that this may be at the expense of oncological outcomes. Also, 6-month data after FLA does not adequately assess oncologic outcomes, and longer-term data will need to continue to be collected to understand the true oncologic impact of this procedure.

Presented by: Brian Chao, MS4; NYU

Written by: Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA,@ssjoshimd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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