Abstract No. 258: MRI-Directed Ultrasound-Guided Transperineal Focal Laser Ablation (TPLA) for Prostate Cancer: One-Year Follow-up of 158 Patients
Transperineal focal laser ablation (TPLA) may be a safe, durable and cost-effective option for patients with organ-confined prostate cancer (PCa), according to a new international study.
Eric M. Walser, MD
Prostate cancer is a slow-growing cancer, but it’s very prevalent, said Eric M. Walser, MD, lead author of MRI-Directed Ultrasound-Guided Transperineal Focal Laser Ablation (TPLA) for Prostate Cancer: One-Year Follow-up of 158 Patients, one of the SIR 2025 Featured Abstracts. Dr. Walser has been focally treating PCa since 2011—but the treatment is still relatively new, and the long-term follow-up is limited.
Because of this, it can be a struggle to establish patient populations large enough to validate the long-term safety and efficacy. However, three clinics in the United States and Europe chose to combine their expertise and findings.
“It was incredibly important to collect our data together, because while there have been many papers on focal therapy, there has been no consensus yet,” said François Cornud, MD, of the Clinique de l’Alma.
Together, the three sites were able to collect 1-year follow-up for 158 PCa patients who were treated between 2018 and 2023.
“There's a lot of tiny studies out there, but they really don't have any power to tell us the importance of this treatment,” said Dr. Walser. “When you start to get up to the numbers that we’re reporting on, we’re able to make some actual, substantial additions to the literature and research.”
The data focused on patients with clinically significant prostate cancer who were treated with TPLA and received follow-up prostate-specific antigen (PSA) tests, MRI scans at 6 or 12 months, and biopsies as indicated. Researchers found that at 6-month follow-up, PSA levels decreased from 7.5 ng/mL to 3.3 ng/mL. The MRI scans of 134 patients found that 30% still showed positive lesions in the treated area, and of the 82 patients who had biopsies, 51% had in-field recurrence. As a result, researchers determined that the TPLA treatment was successful in about 74% of the patients.
“This paper is different from other studies, because you can see huge interinstitutional variability in treating with focal laser ablation,” said Katelijne de Bie, MD, one of the co-authors and a physician in the department of urology at Vrije Universiteit in Amsterdam. “But yet, despite these variabilities, if you look at those three clinics, you see almost no Clavien-Dindo III or higher complications.”
Dr. de Bie said this is important because, despite the variations, it establishes a baseline safety level. In addition, the data showed that TPLA does not impact quality of life.
“Urinary symptoms and erectile function did not change after therapy, so it does implicate no significant effect on sexual or urinary function in our group,” she said. “There were a small number who experienced retrograde ejaculation after the treatment, and some patients with transient urgency. But there are no patients with incontinence, so that is a huge difference compared to radical prostatectomy.”
The quality-of-life differential is important, Dr. Walser said, because in his experience, this patient population is often unwilling to acknowledge the side effects of treatment.
“I've seen so many men who have gone through radical surgery and radiation and have life changing complications and side effects, but they suffer in silence. It can lead to depression and true quality-of-life issues,” he said. “We found that focal laser has really almost eliminated those side effects” According to Dr. Walser, an increasing number of patients are pursuing TPLA as a safe and durable treatment—but few IRs in the United States are performing this procedure.
For Dr. de Bie, it’s important that other physicians understand TPLA is an outpatient clinic procedure that takes less than an hour. “The laser treatment itself takes 10–15 minutes, and the patients can go home within 2 hours,” she said. “And 90% of them or more don’t need a catheter after a few days.”
Dr. Cornud and Dr. De Bie added that, at least at their clinics, TPLA can be done using only local, rather than general, anesthesia.
However, Dr. Walser noted that most IR departments in the United States may not have the correct ultrasound equipment or experience doing MRI intervention in this space. If IRs want to go into the focal treatment of prostate cancer, they must be well-versed in working with these new technologies, he said. But there is a future in this area, he believes.
“MRI intervention is still in its infancy. It's growing,” said Dr. Walser. “It’s catching on in the neuro space for motion disorders and refractory epilepsy but, in other parts of the body, it’s still young. But I think it will develop in time.”
Researchers are still gathering data and looking into longer-term follow-up, as well as ways to standardize their techniques.
Dr. Walser will present his findings at SIR 2025 on Tuesday, April 1, at 3 p.m. during the Prostate 1 session.
