What Is Prostate Laser Surgery
As the name implies, prostate laser surgery uses a scope that delivers a laser directly to the prostate. It is a procedure for patients with prostate enlargement. In most cases, it is used to relieve the urinary symptoms of an enlarged prostate. It is typically the last resource when oral medication and conservative treatment do not work.
During the procedure, your doctor will insert a scope through the urethra. It reaches the prostate just below the urinary bladder. Then, it delivers laser energy directly to the prostate, removing excess tissue and shrinking the gland. The laser works through heat generation, directing heat into a specific spot in the prostate gland. There is not only one type of prostate laser surgery.
There are a variety of other methods, including:
- Thulium Laser Vaporesection and Enucleation of the Prostate
- GreenLight Laser Vaporization , also known as photoselective vaporization, or greenlight laser prostatectomy.
- Diode Laser Vaporization and Enucleation
The Nyulmc/sperling Prostate Cancer Center
Between April 2013 and April 2014, 21 men underwent focal laser ablation as part of a collaboration between the NYULMC Smilow Comprehensive Prostate Cancer Center and the Sperling Prostate Cancer Center. All candidates for this collaborative focal laser ablation of the prostate study signed informed consent to participate in a longitudinal outcomes study.
The selection criteria for focal laser ablation included a 10-year life expectancy, between one to two focal abnormalities on mpMRI consistent with prostate cancer, no Gleason pattern 4 disease on random TRUS-guided biopsies of the normal appearing prostate on mpMRI, focal abnormality on MRI < 15 mm, and no Gleason score over 7. In most cases, preservation of potency was a very high priority. Candidates are extensively counseled regarding the very limited short-term and lack of long-term oncologic outcomes data with focal prostate cancer laser ablation.
Fiber placement T2-weighted axial sequence.
Temperature-sensitive fast spoiled gradient-recalled echo images.
Postablation gadolinium-enhanced T1-weighted axial sequence.
To date, there has been no significant change in the mean AUASS, IPSS, or SHIM between 3 to 6 months and baseline . Incontinence has not been reported by any patient in the perioperative or postoperative setting. The mean preoperative PSA value was 5.40 . Among the 12 patients in whom the 6-month PSA was available, the mean PSA value decreased from 5.10 at baseline to 3.69 at 6-month follow-up .
The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
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More About Ed And Urinary Function
All study patients were treated between 2013 and 2017, with a median patient age of 64 years.
Pre-treatment biopsy Gleason scores were 3 + 3 = 6 in 30.8% of patients 3 + 4 = 7 in 46.7% of patients and 4 + 3 = 7 in 22.5% of patients.
Most of the men had a pre-treatment clinical stage of cT1c. Nearly all of them had either one or two tumor sites on their gland.
This is an admirable mix of patients, suggested Eggener. “I give Dr Walser credit that two thirds of the patients he has treated have Gleason score seven or higher cancers, because most clinicians would agree that it should not be used routinely on people with lower grade cancers,” he said
The median PSA level of patients prior to treatment was 6.05 ng/mL and decreased to 3.25 ng/mL at 12 months post-treatment .
Tumor diameter above the median was the lone statistically significant predictor for a post-treatment positive MRI and thus the need for biopsy and the possibility of a confirmed recurrence.
Walser said that the patients in this study were overall highly educated and affluent. They tended to be white-collar professionals such as engineers and doctors who search online for alternative treatments to prostatectomy. Other alternative treatments including high intensity ultrasound and microwave ablation also appeal to this type of patient, he said.
Currently, FLA is not reimbursed by insurance or Medicare. Walser’s patients come via his Internet marketing or are self-referred.
A New Treatment For Advanced Prostate Cancer Improves Survival In Phase 3 Clinical Trial
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Radiation therapy is getting more precise, enabled by technologies that make it easier to kill tumors while sparing their surrounding tissues. Some newer therapies are even given intravenously instead of by machines, and they deliver radiation particles directly to the cancer cell itself. One of these new therapies a sort of smart bomb targeted at malignant cells is now generating promising data for men with the most aggressive prostate cancer.
In early June, investigators reported results from a phase 3 clinical trial showing that among men who received the experimental treatment, there was nearly a 40% reduction in deaths over the course of the study, compared to men who did not.
The treatment is called lutetium-177-PSMA-617, or LuPSMA, and it has two components: a compound that targets a cancer cell protein called prostate-specific membrane antigen, or PSMA, and a radioactive particle that destroys the cells. Healthy prostate cells dont contain PSMA, or do at very low levels. And some men with prostate cancer have more of the protein than others. Doctors can detect the protein using a specialized imaging scan.
Results after 21 months showed that cancer progression was delayed for longer among the LuPSMA-treated men: 8.7 months on average versus 3.4 months among the controls. The treatment was also associated with better overall survival: 15.3 months versus 11.3 months.
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Other Treatment Options For Prostate Cancer
There are several other prostate cancer treatment options that are available for the patients. Chemotherapy is one of the other popular treatment modality that may be used after surgery for patients with the cancer of the prostate.
The following table highlights the average cost of chemotherapy for prostate in some of the top medical tourism destinations in the world:
- Hormone therapy
- External beam radiotherapy
Thus, the total cost of prostate cancer treatment varies greatly from one individual to another, depending on the individual medical case.
Explore Best Hospitals for Prostate Cancer Treatment
And that was the case for one study published yesterday in the journal Lancet Oncology that received widespread media attention. The results came from a clinical trial testing an experimental laser treatment on men with prostate cancer. And the findings were positive: the therapy is safe to use in these patients.
Thats good news.
But what do the results really mean for men with prostate cancer? We spoke to an expert on prostate cancer, Professor Malcolm Mason, to find out.
The great thing is that this study showed the treatment is safe to give to patients, he says.
Heres what it did show.
How Lupsma Is Changing The Prostate Cancer Space
At the recent 2021 Prostate Cancer Foundation Scientific Retreat, Michael S. Hofman, MBBS , FRACP, FAANMS, FICIS, presented the latest research on LuPSMA for the treatment of advanced prostate cancer.1 He gives an overview on current LuPSMA clinical trials and what these trials hope to accomplish in the prostate cancer space. Hofman is a nuclear medicine physician and director of the Prostate Cancer Theranostics and Imaging Center of Excellence , Melbourne, Australia.
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Fusion Guided Focal Laser Ablation Of Prostate Cancer
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|Recruitment Status : Enrolling by invitationFirst Posted : May 3, 2016Last Update Posted : July 14, 2021|
Prostate cancer is the most common non-skin cancer in U.S. men. Treatments for early or less aggressive disease are limited. Researchers want to test a device that destroys cancerous tissue with laser energy. They want to see if using it with ultrasound is more comfortable than using it with magnetic resonance imaging .
To test a cooled laser applicator system to treat prostate cancer lesions. To see if ultrasound imaging is a practical and feasible treatment with laser ablation for focal prostate cancer treatment.
Men at least 18 years old with prostate cancer seen on MRI that has not spread in the body.
Participants will be screened with standard cancer care tests. These can include physical exam, lab tests, and MRI. For the MRI, they lie in a machine that takes pictures. Participants will have a prostate biopsy. Needle samples will be taken from 12 places in the prostate. This will be guided by MRI and ultrasound, which is obtained through a coil in the rectum.
The cooling catheter will be removed. A different catheter will be put in the urethra to keep the bladder emptied.
An Increase In Available Drug Options
While LuPSMA isnt yet on the market, the sheer number of new medications already available for advanced prostate cancer has been a major research boon in recent years. The proliferation of medications within the advanced prostate cancer space has significantly increased the options available to the treating provider, Dr. Haywood says. Since the time I started urology training, several medications targeting the androgen hormone axis have been approved, resulting in significant expansion of the options available to men with advanced prostate cancer. More on those next.
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The Robotic approach uses robotic technology to mimic the surgeons movements. This surgery requires multiple tiny incisions. It also offers more precision, as it lets your doctor see the prostate in 3-D and magnifies everything 10 times.
Lung and Bronchus Prostate Breast Colon and Rectum Pancreas Top 5 Fatal Cancers in Vermont per 100,000 Population Note: All rates are age-adjusted.
Cancer Research UK.
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Greatest Prostate Most Cancers Therapy By Stage
1 in 8 men in the USA will obtain a analysis of prostate most cancers of their lifetime. Many therapies have been developed for prostate most cancers, however the most effective therapy for youll rely upon the stage of your most cancers, how aggressive its, and different components akin to your age.
Prostate most cancers could be very treatable, and it has virtually a 97% 5-year relative survival rate . However earlier than beginning therapy, its essential to debate your choices with a health care provider or healthcare skilled.
Some therapies are extra aggressive than others, however most may have negative effects. Lets study extra about your therapy choices and how one can finest weigh the professionals and cons of every.
Many therapies have been developed for prostate most cancers, and every comes with advantages and dangers. Theres not often just one appropriate possibility.
Elements that may affect which therapies a health care provider would possibly suggest embrace:
- how rapidly your most cancers is predicted to develop
- whether or not you will have different well being issues akin to diabetes or heart disease
- in case youve had earlier surgical procedure for an enlarged prostate
- the assets obtainable in your geographic area
- the desire of you and your family members
- the attainable negative effects of and points from therapy
Stage 1 prostate most cancers is the least superior stage. This implies your most cancers is small and hasnt superior previous your prostate.
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How Isholep Surgery Done
A general anesthesia is required to keep the patient at rest throughout the procedure. To reduce the chances of infection, an antibiotic is given and the patient is made to lie flat on his back with the legs lifted high. Resectoscope a surgical instrument is inserted through the urethra to have a view of the prostate gland. This allows the surgeon to be aware of where the incisions are made during the surgery.
The laser is placed into the resectoscope and used to free up the enlarged prostate tissue from the capsule , and is sealed for blood vessels. The bladder receives the tissue that was removed. The laser is replaced by the morcellator in the resectoscope. Morcellator is used to suck the tissue present in the bladder. After the removal of tissue, the resectoscope is taken out and the urinary catheter is placed.
Any abnormal findings in the tissue removed after surgery will be treated by prescribing medications. The recovery of the patient will be monitored by repeating the tests, such as bladder scan, symptom score and urinary flow rate. This makes the surgery more effective. Pelvic floor exercises or Kegel exercises should be done to cure problems with urine incontinence.
Prostate Cancer Patients May Soon Have A New Option To Treat Their Disease: Laser Heat Ucla Researchers Have Found That Focal Laser Ablation The Precise Application Of Heat Via Laser To A Tumor Is Both Feasible And Safe In Men With Intermediate Risk Prostate Cancer
The Phase 1 study found no serious adverse effects or changes in urinary or sexual function six months after the procedure. The technique uses magnetic resonance imaging, or MRI, to guide the insertion of a laser fiber into cancerous tumors. When heated, the laser destroys the cancerous tissue.
A follow-up study, presented in a poster presentation at the American Urology Association meeting in May, showed the potential to transfer this treatment for the first time into a clinic setting, using a special device that combines both MRI and ultrasound for real-time imaging. The Artemis device arrived at UCLA in 2009. Since then, 2000 image-fusion biopsies have been performed the most in the U.S. – and this large experience has paved the way for treatment to be done in the same way.
If the laser technique, known as MRI-guided focal laser ablation, proves effective in further studies — especially using the new MRI-ultrasound fusion machine — it could improve treatment options and outcomes for men treated for such cancers, said study senior author Dr. Leonard Marks, a professor of urology and director of the UCLA Active Surveillance Program. Historically, prostate cancer has been treated with surgery and radiation, which can result in serious side effects such as erectile dysfunction and urinary incontinence.
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How Does Laser Focal Therapy Compare To Other Focal Methods
In comparison to another popular focal treatment methods like high-intensity focused ultrasound , laser focal therapy is not limited to only small glands and has demonstrated much higher levels of accuracy with lower risk of side effects such as, erectile dysfunction.
High intensity focused ultrasound uses ultrasound instead of laser to heat the tissue. To obtain the ablation diameter of the laser used in our approach, HIFU would require > 20 overlapping ablations. What if the patient moves a little and the device misses a spot? When treating cancer, its important to get all of it. The vast majority of HIFU centers use ultrasound guidance , losing the precision of MRI and the important real-time information that MRI thermometry provides in protecting vital structures. Studies show significant urinary and sexual problems after HIFU because important tissues and nerves can be damaged during the procedure.
Laser focal therapy boasts many benefits for patients compared to other treatment methods for prostate cancer. No general anesthesia is required for the therapy, and patients are able to return to work as early as the day after the operation. Additionally, laser focal therapy carries lower risk of side effects compared to other treatment methods such as, impotence, and urinary incontinence. Laser focal therapy also does not rule out the exploration of further treatment options such as surgery or radiation therapy if needed later.
*Results may vary
Light Therapy Effectively Treats Early Prostate Cancer
20 December 2016
A new non-surgical treatment for low-risk prostate cancer can effectivelykill cancer cells while preserving healthy tissue, reports a new UCL-led phaseIII clinical trial in 413 patients.
The new treatment, ‘vascular-targeted photodynamic therapy’ , involvesinjecting a light-sensitive drug into the bloodstream and then activating itwith a laser to destroy tumour tissue in the prostate. The research, publishedin The Lancet Oncology, found thataround half of patients treated with VTP went into complete remissioncompared with 13.5% in the control group.
“These results are excellent news for men with early localised prostatecancer, offering a treatment that can kill cancer without removing ordestroying the prostate,” says lead investigator Professor Mark Emberton,Dean of UCL Medical Sciences and Consultant Urologist at UCLH. “This istruly a huge leap forward for prostate cancer treatment, which has previously laggeddecades behind other solid cancers such as breast cancer. In 1975 almosteveryone with breast cancer was given a radical mastectomy, but since thentreatments have steady improved and we now rarely need to remove the wholebreast. In prostate cancer we are still commonly removing or irradiating thewhole prostate, so the success of this new tissue-preserving treatment iswelcome news indeed.”
The trial involved 47 treatment sites from ten different Europeancountries, most of which were performing VTP for the first time.
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