MRI Guided Focal Laser Ablation

Aytekin Oto, MD, MBA, Professor of Radiology and Surgery and Chair of the Department of Radiology at the University of Chicago, discusses MRI guided focal laser ablation for prostate cancer including challenges and future considerations. He first describes the benefits, technique, and trial data showing 1-year, 3-year, and 5-year follow up. Focal laser ablation is minimally invasive and targets lesions while sparing surrounding tissue and preserving options for future treatment. Dr. Oto notes that the goal of this therapy is to replace surgery and radiation, but not active surveillance. Currently, MRI guided focal laser ablation is offered at five centers in North America, is conducted mostly transrectally, and is sometimes reimbursed by insurance. Dr. Oto identifies several key challenges to this therapy: lesion mapping, monitoring and planning while in procedure, and high local recurrence. He states the importance of considering other ultrasound guided procedures and notes that one of the limitations of MRI guided focal laser ablation is underestimating prostate volume. For this reason, he introduces hybrid multi-dimensional MRI that may help address this issue. Dr. Oto concludes that MRI guided focal laser ablation is both a safe and feasible treatment and underscores the importance of imaging in determining patient eligibility and accurate planning. Lastly, he adds that local recurrence must be addressed in long-term follow-up.

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