Background Despite growing research interest in focal therapies for localized prostate cancer (PCa) tumors, no large cohort studies have evaluated the oncological outcomes of US-guided transperineal focal laser ablation (TPLA). Purpose To evaluate the 12-month oncological outcomes of MRI-directed US-guided TPLA in patients with localized PCa. Materials and Methods Patient data from four centers in Europe and the United States (May 2018 to July 2023) were retrospectively analyzed. Single-fiber or multifiber TPLA was performed (1064 nm, 3-5 W) for biopsy-confirmed, MRI-delineated Prostate Imaging Reporting and Data System (PI-RADS) 3 or higher lesions. The minimum follow-up was 12 months and included prostate-specific antigen (PSA) and PSA density (PSAD) measurements, MRI, and protocolized or MRI-indicated biopsy. MRI positivity was defined as a PI-RADS 3 or higher lesion at follow-up imaging. In-field recurrence (IFR) was defined as biopsy-proven PCa within the treated area; the IFR of clinically significant PCa (csIFR) was defined as a Gleason score (GS) of at least 3+4. Predictors of csIFR were assessed at three predefined stages (preoperative, perioperative, and postoperative). Stage-specific mixed-effects multivariable analyses were conducted with variables that were statistically significant in univariable analysis after accounting for known predictors. Results Overall, 195 men (median age, 69 years; IQR, 63-74 years) underwent TPLA for 206 lesions, of which 32% were GS 3+3, 48% were GS 3+4, 29% were GS 4+3, and 7% were GS 4+4. The median initial PSA level was 6.8 ng/mL (IQR, 5.4-9.0 ng/mL), and the median tumor length was 11 mm (IQR, 9-14 mm). csIFR was detected in 36 of the 206 (17%) lesions, with an overall IFR rate of 49 of 206 (24%). An initial PSAD greater than 0.16 ng/mL2 was an independent preoperative predictor of csIFR (odds ratio [OR]: 2.62; 95% CI: 1.01, 6.89; P = .049). Postoperatively, positive MRI findings were predictive of csIFR (OR: 67.87; 95% CI: 18.74, 246.01; P < .001), with 83% sensitivity and 89% specificity. Conclusion In this multicenter study, MRI-directed, US-guided TPLA of 206 localized PCa lesions resulted in a 12-month csIFR rate of 17%. Post-TPLA positive MRI findings were highly predictive for csIFR. ClinicalTrials.gov identifier: NCT05163197 © RSNA, 2026 Supplemental material is available for this article.
Radiology. 2026 Jun [Epub]
Katelijne C C de Bie, François C Cornud, Eric M Walser, Luigi A M J G van Riel, Stefano Regusci, Martina Martins Favre, Rene E Zimmer, Marc Galiano, Guglielmo Manenti, Andrea Micillo, Jorg R Oddens
Department of Urology, Amsterdam University Medical Center, VU University, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands., Department of Radiology, Clinique de l'Alma, Paris, France., Department of Radiology, University of Texas Medical Branch, Galveston, Tex., Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands., Department of Interventional Oncology, Swiss International Prostate Centre LTD, Geneva, Switzerland., Department of Radiology, Swiss International Prostate Centre LTD, Geneva, Switzerland., Department of Urology, Clinique de l'Alma, Paris, France., Diagnostic Imaging and Interventional Radiology Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.