Something Else to Look Into

I had a Multidisplinary clinic on Wednesday Dr. Pinto thought i would be a good candidate for Focal Laser Ablition. Does anyone have any information on this? I know this is very new but was wondering if anyone has done this procedure.

Joey - what's your diagnosis again?

- Allen

I hope you're taking Proscar or Avodart - you may find that your insignificant cancer becomes undetectable just with that.

FLA is controversial. As you know, PC is almost always a multifocal disease - there are very small amounts of cancer throughout the prostate even when they are not detected by a biopsy. Proponents of focal ablation argue that there is an "index tumor" that is seeding all the others, but that theory is far from proven. In fact, men who have had this done often go in for multiple procedures. Lots of outstanding questions about focal ablation:

• Since you are low risk, what is the point of doing it rather than AS? Proponents say that it gives the patient a feeling that he is doing something rather than just waiting. They argue that even if it doesn't stop progression, it may at least slow it down. But just taking Proscar or Avodart may accomplish the same thing.

• If for some reason you don't want to go on an AS program, why not do SBRT or one of the brachys and be done with it? There is little advantage in terms of SEs.

• With multiple FLA procedures, do the risks of SEs increase?

• What is the salvage after multiple procedures fail?

• Even if the index tumor theory is true, it seems that there is a margin outside the "kill zone" where any cancer cells there are not killed, but just go into cell cycle arrest temporarily while they prepare to re-propagate. Cancer stem cells may be particularly good at evading ablation. mpMRIs cannot detect the cancer's margins with the needed accuracy to prevent this.

• Lasers destroy by heat, and heat travels. So tumors at the prostate edge near the bladder neck, urethral sphincter, or rectum are risky for such treatment. Will this doctor say "no" if that is the case, or is he a hot dog?

I'm not saying it's good or bad, just offering some points to consider.

Joey,
There probably isn't a doctor in the world who can answer that question as well as Sean Collins can. He does more research than just about anyone on SBRT. Be sure to ask him about rectal spacers.

- Allen