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My Focal Laser Ablation for PCa

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Posted 11/13/2015 4:26 AM (GMT 0)
It has been a while since I have been on this site but wanted to share my story for those considering their treatment options. I was diagnosed in May after a positive biopsy which was performed as a precaution after having some blood in my urine and a 3.29 PSA at age 48, 3/12 postive cores, mostly gleason 6 with a bit of G 3+4 in one core. Urologist still not sure of the cause of bleeding, maybe a kidney stone, it lasted a day and went away. Someone above was telling me to get checked out.

After diagnosis, I went to a leading cancer center in Boston, met with an oncologist, surgeon, and radiologist. They said my options were radion or surgery and all three recommended surgery. I searched for a surgeon, found someone my wife and I liked in Boston, cancelling an appointment with Dr. Scardino at MSKK. The surgeon scheduled a 3T MRI which showed two lesions, one in each lobe (1.2 cm & 6 mm) My PSA had dropped to 2.3 when I had the MRI in August. The smaller lesion was only 6 mm from one of my NVBs making the surgeon unsure if he could save the nerve and would decide during the procedure. Frankly, many of the stories I read on this site of incontence and ED problems had me terrified of the sugery and a lifetime of pumps, viagra, and needles with trimix. I postponed the surgery to further evaluate my options as I had started researching focal therapies two weeks earlier after stumbling accross it searching the web.

I spoke with several specialist performing focal therapy, including cryo, hifu, and laser. I ended up choosing Focal Laser Ablation (FLA) at the University of Texas (UTMB) with Dr. Eric Walser. I was treated last week as an outpatient. The staff at UTMB was terriffic. The procedure inserts a laser fiber into the tumor while guided while in a 3T MRI machine. The laser then destroys the lesion with precision which is confirmed by the live MRI imaging. The procedure lasted two or three hours, or so am told. Once complete, I had burning urinations and a weak stream for about 12 hours. I was tired from the anethesia but walked out of the hospital about 7 hours after I arrived, wend to the hotel, ordered room service and went to sleep. The next day, I felt about 80% of normal and flew home. My biopsy was a very painful experience, amazingly, there was no pain in the prostate from the ablation.

The UTMB team had some concerns with ED due to the bilateral nature of my PCa and proximity to the NVB. I have had no issues with incontinence. I can confirm with the help of my wife, 5 days post FLA, I have no ED issues.

The next step is a follow up 3T MRI at six and twelve months to confirm the lesions are gone with no additional areas of concern. Only time will tell if this was successful as the procedure has only been around a few years. In my case, the expectation of fewer side effects out weighed the 'gold standard' of the RP. Should the PCa return, I can re-ablate or still chose the more traditional treatments which are all open to me. For those on this site with low or intermediate risk PCa such as myself, FLA is a treatment option worth considering.
Posted 11/13/2015 12:56 PM (GMT 0)
Great report. Great method of research and considering side effects before deciding on a treatment method. Here's to continued success.
Posted 11/13/2015 1:51 PM (GMT 0)
Thanks for this superb write-up Wolfster; it is of particular interest to me as FLA is second on my list after AS should I need to seek treatment. I'll certainly be hitting you up for guidance if I have to walk this path (please)!!!

One question; did you manage to get insurance (of some sort) to pay for all/part of this or did you have to private pay?

A personal note for other forum members interested in FLA:

I'm currently working through the diagnostic process at Johns Hopkins. As part of that process (across several weeks) I have written to my Urologist there on 5 occasions using the prescribed method (MyChart) to ask specific questions and/or express a heartfelt concern about an upcoming procedure (this against the background in my medical history that I am medicated for depression and represent a potential suicide risk (that's not a threat mods - just a background fact :o) )). After my first 3 messages were totally ignored I asked in the fourth if my message was even received and got back "yes it was" and the remainder of my message totally ignored one again. While I would not question the level of medical expertise at JH, I take real issue with the user interface... but that's my problem to deal with.

Fast forward...

It happened that one recent Saturday I was researching PCa and feeling pretty low when I happened upon FLA and a few threads here and elsewhere that also led me to Dr Walser. I was so encouraged by what I read that I guessed at his email address and fired off a "Dr Walser you are a star, I'm so glad I found you, if I end up in this boat I would dearly like to talk". I thought little more of it but started to feel substantially better that I had found a light at the end of this tunnel I thought I could work/cope with.

Three hours later on a SATURDAY afternoon I had a very warm and friendly email back from Dr Walser, thanking me for my kind words and asking me to send my recent mp3TMRI to him on CD for review. An hour later he sent another email connecting me to his nurse/assistant/fixer of all things Donnie. Half an hour later I had an email from Donnie saying 'Hi' and giving me details of where to send the CD to. I spent the next 2 weeks literally wrestling such a CD out of Hopkins and duly sent it along to Donnie.

A week later I got an email back from Donnie; "Dr Walser has reviewed your MRI and if your biopsy comes back positive feels that your lesion would be amenable to FLA, please keep us posted".

This seems to be the measure of the man and UTMB; they still practice the 'CARE' in Healthcare. I've not paid Dr Walser a penny BTW.

I can't speak highly enough of my experience so far and WILL be beating a path to this man's door if the cards fall that way for me; just an FYI.

Paul yeah
Posted 11/13/2015 1:56 PM (GMT 0)
Wolfster, thanks for the excellent update; I'm really happy that it went so well. Please return often and give us updates. We don't have many members who have chosen your path. Your experience (and that of Paul's if he chooses this) can be of great help to new members and great education for the rest of us.

Jim
Posted 11/13/2015 2:05 PM (GMT 0)
Thx for that excellent report. Had my risk allowed it- or if I had even known about it- I would most certainly have been pursuing such an approach.
Posted 11/14/2015 1:46 AM (GMT 0)
I love a good story with a happy ending, especially when it's true! Great to hear. Do you know what the size and position of the treated tumors were? (I love details)

You may be interested in an internet radio interview on Tuesday at 5PM EST with a specialist in HIFU focal ablation, which was recently approved for use in the US. There's an opportunity for listeners to ask questions:

CureTalk: HIFU for prostate cancer

- Allen
Posted 11/14/2015 12:25 PM (GMT 0)
Thanks for the post, please keep us updated.
Posted 11/14/2015 5:20 PM (GMT 0)
Hi Guys

Following up to answer some of the questions posted above. My HMO approved this procedure out of network but UTMB does not accept insurance for this because they have received very low reimbursements compared to the cost of the procedure. I paid out of pocket and will be submitting directly to my insurance company for reimbursement, I don't know how much I will receive back.

Regarding the depression mentioned above, there are numerous holistic procols on the web for treating cancer. I had several of these going including essiac tea, budwig protocol, raising my PH through diet, and getting more exercise. I don't know if they helped, but my PSA did drop from 3.5 on 7/1 to 2.3 on 8/4, it was 2.67 on 9/15. The thought I was at least doing something while I was researhing helped me cope and stay positive.

The staff at UTMB is awesome, Donnie was quick to reply to all our questions, kept my wife updated during the procedure, and Dr. Walser followed up with me over the weekend to see how I was doing. They are all passionate about helping men fight this disease

The truth is I was lucky to have received a 3T MP MRI. I did not understand there was a difference in MRIs at the time, but it allowed me to have my images sent to Dr. Walser where he read them at no charge, who determined I was a candidate for FLA. There are a handful of places performing this procedure, I sent the write up of my MRI and biopsy resulst so to several places. MSKK the Universty of Chicago, told me I was not a candidate because of having two lesions. University of Colorado said maybe but I should have a Polaris test first, Dr. Sperling in NY said I was a candidate, UCLA has a study in progress but had no shortage of candidates. One person wanted me to go off shore for HIFU as it was not FDA approved in the US at this point. Trials at the national institue of health. I chose UTMB because Dr. Walser took the time to read my MRI, performed the procedure within the hospital, has performed more than anyone with the exception of Dr. Sperling, and I felt was dedicated to the science vs. turning a profit.

To Tall Allen: , my 1.1 cm G 3+4 on the right was at approximately 1:00, in contact with the prostatic margin and 1.2 CM from the right NVB. The 6 mm G 3+3 on the left was at 7:00, on the left, also in contact with the prostatic margin and only 6mm from the left NVB causing the concerns over nerve sparing. The 3T MP MRI showed no evidence of PCa leaving the prostate. UTMB said my imaging was really good quality, I had both the ER coil and the device put on the abdomen.

Since this went so well for me, I feel obligated to make others aware of this alternative procedure. The surgeon I consulted with in Boston was a few years older than me and said we all have cancer cells in the prostate, even his, but mine needed to be treated and were probably growing for 20 years. He told me he thought focal treatments would be the future but also thought at my age I should have surgery. I realize there are probably small cells not visible in the MRI which remain, however, I am optimistic the clock was reset with the agressive lesions and I bought myself some time for additional innovation treating PCa.

There is not enough focus on PCa, It would be nice to see the same level of support as beast cancer with the NFL wearing blue ribbons, shoes, etc in November. When you see your friends, co-workers growing beards this Movember, contribute to their fund raisng as the funding goes towards mens health issues including PCa.
Posted 11/15/2015 1:26 AM (GMT 0)
Wolfster: Great report! I sincerely believe your procedure will be the thearapy of the future. I see this procedure as a real possibility should recurrence show its ugly head. The very best wishes to you and please keep us updated.
Posted 11/15/2015 2:55 AM (GMT 0)
Hi Wolfster... Great report on FLA. Not many things written here on it and your post and follow-up had a lot of info. I hope you are as lucky in the reimbursement as you are with the FLA. Take care. -JR
Posted 5/27/2016 12:07 PM (GMT 0)
I resurrecting this thread to post the six month follow up results of the 3T MRI I had earlier this month and PSA test after my FLA procedure at UTMB last November. I had the MRI at in Boston and it was read at both Dana Farber and UTMB and showed no evidence of cancer. My PSA also dropped to 1.85 from 3.29 when I was diagnosed a year ago tomorrow and 2.7 just before I had the FLA procedure last Fall.

It has been a long year learning about this disease and treatment options. Fortunately, I stumbled into learning about focal treatments after surgery had been recommended and the surgeon could not confirm he could save both nerves. I have no continence or ED isues and am not taking any medications. I seem to have managed to preserve my quality of life.

I am still battling the insurance company who approved the procedure but only paid about 5% of my out of pocket cost. There are other alternatives to surgery and radiation. If you have low to intermediate risk PCa, this is a treatment worth exploring!
Posted 5/27/2016 3:45 PM (GMT 0)
Thanks for the update. Good news for you, and also for others who are interested in hearing about focal treatments.

While the comments and preliminary studies I have read about FLA are encouraging, it appears to require 3 or 4 hours or more under sedation. This would appear to be a full surgical procedure, while making minimal incisions.

Do you know if FLA is recommended for all patients, or this there an upper age limit, as exists for most prostatectomies?
Posted 5/27/2016 5:06 PM (GMT 0)
Thanks for the update, and please continue to keep us informed. I have lots of questions for you, if you don't mind, since you are our resident expert du jour:

1. What has been the effect, if any, on erectile and orgasmic function? Are you using ED meds, and if so, do they work well?
2. Have you retained the ability to ejaculate? reduced volume? Has it changed appearance?
3. What kind of changes in your urinary function have you experienced? Are they all resolved? Any rectal SEs?
4. Your PSA is now at 1.85 - what is Dr. Walser's expectation for it? How will he use it to monitor progression?
5. Will you have a follow-up biopsy? Possibly a transperineal template mapping biopsy? What is the follow-up plan?
6. If residual cancer is found by biopsy, either in the ablation zone or elsewhere, will you be re-treated? What is Dr. Walser's re-treatment rate, and what SEs does he see with retreatment?

My understanding from Dr. Marks at UCLA (who did a small pilot study) is that only a spinal block is required and he did them in his office. He said that the lack of need for general anesthesia is an advantage for FLA. The biggest practitioner in the LA area is John Feller in Indian Wells. I will be visiting him next month with a patient. Insurance coverage is challenging. May I ask what you paid out of pocket?

- Allen
Posted 5/28/2016 3:17 AM (GMT 0)
hi Allen,
I am happy to answer your questions. Please see below:



1. What has been the effect, if any, on erectile and orgasmic function? Are you using ED meds, and if so, do they work well? no real issues with ED or function. I am not taking any ED meds, they did put me on 5 mg of Cialis to help speed healing to any nerves which may have been damaged especially since I had bi-lateral ablation. I stopped taking it after a month as I did not need it.

2. Have you retained the ability to ejaculate? reduced volume? Has it changed appearance? No issues with ejaculate although I believe the volume is reduced. No change in appearance. After the procedure it was no where near as red/brown as when I had the random biopsy.

3. What kind of changes in your urinary function have you experienced? Are they all resolved? Any rectal SEs?
My only real issue is I have more of a sense of urgency when I need to go especially when I have a few cocktails.

4. Your PSA is now at 1.85 - what is Dr. Walser's expectation for it? How will he use it to monitor progression?
Dr. Walser's did not want me to have a psa test until six months after ablation because of the damage done to the prostate with the ablation. I did have one done at four months and it was 2.23 and then a few weeks ago at six months and it was 1.85. Dr. Walser told me it is best if PSA is cut in half from pre-ablation levels. I will have a PSA test every three months.


5. Will you have a follow-up biopsy? Possibly a transperineal template mapping biopsy? What is the follow-up plan? I had the 3T MRI at six months post ablation, I will have another MRI on the one year anniversary. If the one year MRI does not show any PCa, I will then have an MRI every year.

6. If residual cancer is found by biopsy, either in the ablation zone or elsewhere, will you be re-treated? What is Dr. Walser's re-treatment rate, and what SEs does he see with retreatment? If residual cancer does show up on the MRI, I would likely have a biopsy targeted at the area in question vs. a random biopsy. The procedure can be repeated should the PCa appear again. I believe the side effects would be the same if I needed to have FLA again. The retreatment rate is $10,000 within a year.

My understanding from Dr. Marks at UCLA (who did a small pilot study) is that only a spinal block is required and he did them in his office. He said that the lack of need for general anesthesia is an advantage for FLA. The biggest practitioner in the LA area is John Feller in Indian Wells. I will be visiting him next month with a patient. Insurance coverage is challenging. May I ask what you paid out of pocket? I believe I was given Lorazapan(same as with a colonoscopy), at one point I recall waking up in the MRI machine and then I went back to sleep. I had no need for any pain killers after the procedure, I did not even take a Tylenol. I paid $20,000 up front. My HMO approved it out of network but only reimbursed approx. 5%, I am now in the appeals process.
Posted 5/28/2016 3:36 AM (GMT 0)
Thanks for bringing in the update. Continued success. ..
Posted 5/30/2016 1:49 AM (GMT 0)
on Inspire there is some 4600 posts on this subject under "Focal Laser Ablation patients"
Posted 5/30/2016 3:11 AM (GMT 0)

ao said...
on Inspire there is some 4600 posts on this subject under "Focal Laser Ablation patients"

My impressions of that website's FLA thread is that it is more of an advocacy vehicle for providers and enthusiasts than for a balanced discussion of various prostate cancer treatments.

Don't get me wrong - I am all for FLA being successful and becoming a few-side-effects alternative to the predominant treatments. But, the posts there seem to me to be heavily biased towards FLA, perhaps before it is fully demonstrated to be effective.
Posted 11/17/2016 3:40 AM (GMT 0)
Hi Guys,
I am writing to provide an update on the results of the 3T MRI done earlier this month on the one year anniversary of my FLA at UTMB last in Nov 2015 to treat my two PCa lesions. The MRI was done at Brigham & Woman's in Boston and read by both the radiologist in Boston as well as Dr. Eric Walser at UTMB who performed the FLA. My PSA reading in May at the six month MRI was 1.85 and earlier this month it was 1.82. My next check is a PSA test in May 2017 and an MRI/PSA on my two year anniversary in Nov 2017.

I have not experienced any ED or incontinence. I feel blessed to have stumbled upon this procedure and am grateful for Dr. Walser being a pioneer in this area and accepting me as a Dr. candidate. Hopefully the trend continues. I would encourage those with early to intermediate stage PCa to research and consider this treatment alternative.
Posted 12/12/2016 10:46 PM (GMT 0)
Wolfster,
I am VERY interested in learning more about FLA. I thought it was still experimental. Hoping this might be an option for me. Encouraging, but not getting my hopes up just yet. Hoping there's a way to contact you to discuss.
Posted 3/20/2019 7:46 PM (GMT 0)
Wolfster - I'm wondering if there are any updates to this now 3 year-old thread. How're you doing? Still very well, I hope!
Posted 4/9/2019 7:06 PM (GMT 0)
I am not Wolfster, however, I also had Focal Laser Ablation for my 4+3 PC 11 months ago. Have zero side effects. PSA currently at 2.33, down from a high of 8.43 prior to FLA procedure in May of this past year. My 6 month follow up 3TMRI was all clear. Will go back for my one year follow up MRI in early June. Certainly optimistic for my future. Also recognize that with a 4+3, I was in an intermediate unfavorable risk group with my diagnosis. Even if my cancer were to return, all my options are still open. I could do FLA again, Robot prostatectomy, or multiple different forms of radiation therapy. Hopefully I will not need additional treatment. Time will tell. At minimum, I have kicked the can down the road to avoid more invasive treatment and it seems to have worked! FLA is not for everybody, but for me it has been an excellent choice.

PC Legacy
Posted 3/1/2021 5:18 PM (GMT 0)
Hi. Hoping evrething continues great!! Any updates on PCa after these yeas of having the FLA? Considering my options. Thanks!
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