What To Expect

MRI Guided Focal Laser Ablation of Prostate Cancer and/or BPH

Dr. Karamanian and Nurse Donnie provide our personal cell phone numbers to every patient we ablate.  This way our patients can always reach us.  In addition, we meet with each ablation patient the day before the procedure, the day of the procedure, and the day after the procedure.  The day before, we perform a non-invasive physical, give a shot of antibiotics (decreasing the risk of infection), review the MRI images, discuss the risks, benefits, and alternatives of the procedure, answer all questions, review instructions, and finalize paperwork.  Early the next morning, we perform the procedure, and patients will go back to their hotel room shortly afterwards.  The day after the procedure, we see each patient again to see how they are doing, give another shot of antibiotics (again, decreasing the risk of infection), review the MRI images from the procedure, answer questions, and provide more instructions.

The day of the procedure, you will have an intravenous catheter (IV) inserted in your arm so that we can provide you with IV antibiotics, pain medications and fluids (to maintain hydration). After providing IV versed (similar to valium) and placing lidocaine jelly to help decrease sensation, you will have a urinary catheter placed so that we can provide cooled urethral saline protection (CUSP). For cancer, this catheter is usually removed the next morning. For BPH, this catheter is usually removed a week after the procedure (most patients fly home with it in and written removal instructions are provided).

You will be positioned prone (on your stomach) on the MRI table for the procedure. IV conscious sedation medications (fentanyl and versed) are administered. A small rectal probe (the diameter of an index finger in width) covered in numbing lidocaine jelly will be inserted in the rectum.

By using this machine, Dr. Karamanian is able to move the laser precisely.​

During the procedure, Dr. Karamanian can accurately use real-time 3T MRI to visualize the target, guide placement of the laser fiber, and ablate (destroy) cancer cells or for BPH, an overgrown transitional zone, while protecting healthy tissue with “safety markers” that are positioned at the urethra and neurovascular bundle. This helps monitor sensitive structures to decrease risk of damage to urinary and sexual function.
  1. Pre-procedure MRI confirms the location and boundaries of the target(s).
  2. The DynaTRIM device is calibrated to the images, and the parameters (knobs) are adjusted to an appropriate three-dimensional approach.
  3. The thin, 1.85mm cooling cannula and FDA cleared laser fiber is then placed into the target through the inner channel of the rectal probe under MRI guidance. Cooled urethral saline (CUSP) is performed through the placed Foley catheter.  The laser is then activated at a low power to confirm appropriate location with the heat from the laser being monitored with real time MRI thermometry in two separate planes. Only after this final confirmation, Dr. Karamanian will increase the laser to treatment level power, monitor the tissue being ablated and make appropriate adjustments to contour the ablation zone.
  4. The laser fiber is usually then repositioned to provide multiple overlapping ablations. Because Dr. Karamanian believes in obtaining wide margins, he will usually perform many overlapping ablations (depending on the individual patient’s situation) which, with cancer, will provide wide margins, and with BPH will provide greater tissue destruction with the goal of better long term results.  The entire procedure is usually finished within about 2-4 hours.
  5. Results are confirmed with a contrast enhanced MR images.
  6. For cancer patients, the Foley catheter is usually removed the next morning.  For BPH, the Foley catheter is usually removed a week after the procedure (often by the patient after flying home—written instructions are provided).

Example Images:

Preablation

Cancer in the left peripheral zone

Ablation

Focal tissue destruction

6 Months Later

Cancer no longer seen

Neurovascular bundle = Blue Arrow
Cancer = Red Arrow