What to Expect
Laser Focal Therapy for Prostate Cancer

The Procedure

• On the day of the procedure, you will have an intravenous catheter (IV) inserted in your arm so that we can provide you with IV antibiotics, pain medications, and fluids to maintain hydration.
• After providing IV versed (similar to valium) and placing lidocaine jelly to help decrease sensation, you will have a urinary catheter placed to provide cooled urethral saline protection (CUSP).  
• You will be positioned prone (on your stomach) on the MRI table for the procedure. IV-conscious sedation medications (fentanyl and versed) are administered.
• A small rectal probe (the diameter of an index finger in width) covered in numbing lidocaine jelly will be inserted in the rectum. By using this machine, the doctor can move the laser precisely.  

During the procedure, the doctor can accurately use real-time 3T MRI to visualize the target, guide placement of the laser fiber, and ablate (destroy) cancer cells and/or excess tissue putting pressure on the urethra. This helps monitor sensitive structures to decrease risk of damage to urinary and sexual function.  

The doctor reviews the pre-procedure MRI together with the newly acquired images to confirm the location and boundaries of the target(s).  

• The DynaTRIM device is calibrated to the images, and the parameters (knobs) are adjusted to an appropriate three-dimensional approach.  
• The thin, 1.85mm cooling cannula and FDA-cleared laser fiber is then placed into the target through the inner channel of the rectal probe under MRI guidance.
• Cooled urethral saline (CUSP) is performed through the placed Foley catheter.
• The laser is then activated at a low power to confirm appropriate location with the heat from the laser being monitored with real-time MRI thermometry in two separate planes. Only after this final confirmation will the doctor increase the laser to treatment-level power, monitor the tissue being ablated and make appropriate adjustments to contour the ablation zone.  

Next, the laser fiber is usually repositioned to provide multiple overlapping ablations. Because our doctors believe in obtaining wide margins, they’ll usually perform many overlapping ablations (depending on the individual patient’s situation) which will provide wide margins with the goal of better long-term results.

Duration

The entire procedure is usually finished within about 2-4 hours.

Results

Results are confirmed with contrast-enhanced MR images.