Has anyone heard of laser ablation without biopsy at Sperling?

I am a 64 year old male in good health, exercise regularly and eat well and in moderation. I have no history of Pca on my mother’s side, I do not know about my father’s side. The only cancer I have had to date is a bit of squamos cell on my arm.
After some rising PSAs, between 5.1 and 7, I had an 1.5t guided MRI biopsy that was negative. After 2 months of cipro I retested PSA 5.36, free PSA 7. I have been trying to decide on a next step.

I was on the phone with the office manager( not sure if that is his title)at the office of Dr. Sperling, who offers 3t MRI biopsies and laser ablation. They O.M. was, of course, highly praising the doctor's skill and equipment, and said that with the doc's advanced equipment(he uses a siemen's MRI, no endorectal coil. The office manager said it casts a shadow) Dr. Sperling sees the results in realtime and can tell if a spot is cancerous and how aggressive it is and often can ablate it right on the spot, without a biopsy. I know that a number of men posting on these boards have used Dr. Sperling. Has anyone had laser ablation during the MRI, without a biopsy? I had not heard of this, and was not aware that imaging could provide a definite dx for cancer, as well as its aggressiveness. Dr. Sperling does not come cheaply, the mri is $2500, and ablation is $30,000. Payment is up front. I don't believe my insurance would pay for it.

Thanks for the reply Tall Allen--I did indeed celebrate the negative finding. I have another post on this site that goes more into the details of my case so I won't repeat them all here, but since my PSA remained relatively high, and my free PSA is in the danger zone, I am not sure if doing waiting is the right step. My 1.5 T MRI guided biopsy with endorectal coil did find 2 suspicious areas in the lateral lobes, which the were marked as about 50% chance of having cancer. 5 cores were taken, and all were negative. The American Urologist I consulted in Japan looked at the MRI shots and said that the Transition and anterior areas were not visible, and that I should either rebiopsy with a standard 18 point TRUS, or do what you suggested, go on proscar(THe MRi showed BPH, as well as inflammation), and test again down the road. Anyway, as I said, the relatively high PSA, and especially, the 7 free PSA are worrisome...

The other thread he mentions: www.healingwell.com/community/default.aspx?f=35&m=2785750 -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard) : 7/7/2013 7:30:39 AM (GMT-6)

Tall,

A MRI with an endorectal coil produces better images of some parts of the prostate than others. The signal to noise ratio of the image depends on the distance from the coil (and which sort of coil is used.) The gross features of the prostate are visible throughout but the resolution in the anterior apex and transition zones is sometimes less than one might wish.

Here's a fairly recent paper with some images that show some of this: www.ncbi.nlm.nih.gov/pmc/articles/PMC2832222/.

Of course some of those areas are also hard to sample with a sextant biopsy too.

You might want to check out Komatta's other thread (link above) since this laser ablation thread is a side issue.

There are three zones that are often used to report prostate MRI. Peripheral, central (transition zone), and the fibromuscular stroma.
There is an app for iPad on prostate MRI for radiologists if anyone wants to go into medical details, called " Prostate MRI".

Hey Komatta,
Ive done my research and it seems that dr.sperling has some sort of technology where he is able to view the entire prostate with the 3t mri machine. Then he is able to tell you by looking at the prostate if there is a tumor the size etc. I have heard of people not wanting a biopsy if they have a tumor cause of the side effects that can occur from having a biopsy, like seeding, infection, etc. and just want to go for the laser ablation. But I do think he does a biopsy for confirmation. But its not like your traditional biopsy , hje uses special targeting and then maps out whole gland. seems very thorough. Just go to his website all the information is there about what you’re asking. www.sperlingprostatecenter.com
I hope that helps.

-J

I have a family member that had this procedure done successfully, though not by the same doctor (at a much lower cost though). Please PM me if you'd like more information. Best wishes to you.