Laser Focal Therapy for Prostate Cancer
Laser Focal Therapy
Laser focal therapy (LFT) can be a compelling option for patients who are candidates.
With MRI guidance, we can often localize your cancer (or at least its most dangerous part) to one or two regions of the prostate. We can then place a laser fiber under MRI guidance into those areas.
The MRI provides an provides an additional, powerful tool by demonstrating real-time heat maps of the areas of tissue destruction.
Although side effects are possible with any procedure, in appropriate patients LFT can treat the cancer with a lower risk of serious side effects compared to traditional treatments [1-5]. Looking for more information about what to expect?
Advantages of Laser Focal Therapy
A minimally invasive outpatient procedure
Relatively Rapid Recovery
Tends to have fewer disruptions to daily life compared with traditional treatment
No General Anesthesia
Uses local anesthesia and moderate, conscious sedation
Decreased Risk of Side Effects
LFT has a lower reported incidence of erectile dysfunction and urinary incontinence than radical prostatectomy[2,3] and radiation therapy[4,5]
If necessary, LFT is a repeatable procedure
If necessary, surgery and radiation are options.
RP [radical prostatectomy] was not complicated by the FLA procedure.” 
Learn About Prostate mpMRI and Guided Focal Laser Therapy for Prostate Cancer
This video begins by describing the diagnosis of prostate cancer starting with a TRUS biopsy vs MRI. It then describes the advantages and disadvantages of different treatment approaches and provides examples of images from laser focal therapy cases.
Frequently Asked Questions
A minimum of 4 days and 3 nights, starting with the day prior to the procedure (where the physician will want to see you in his office no later than 2 or 3 pm). If you want to stay longer, we are happy to take care of you throughout your stay.
For individuals traveling from outside the Houston area, we can recommend hotels as well as transportation options to help ease your travel planning.
You are provided with both a nurse’s and physician’s cell phone numbers.
For Cancer Treatment:
Private insurance will usually not cover a significant portion of the procedure. You can try calling your insurance with these codes and asking:
The CPT code is 55899 and the ICD code is C61.
Medicare is complicated, but the answer is generally no.
The “Blue Laser” is marketing term. The laser system that is most commonly used is the Visualase laser system which has two available laser fiber optics: a smaller one with a blue plastic cover and a slightly larger one with an orange plastic cover. In order to create wider ablation zones for better margins (for cancer) and larger tissue destruction (for BPH), we use the slightly larger fiber optic.
We exclusively use the Visualase laser system.
We take many steps to minimize the risk of infection, including a IM or IV shot of antibiotics the day before, the day of, and the day after the procedure.
In addition, we prescribe a course of oral antibiotics. We have patients perform a fleet enema the evening before and the morning of the procedure.
Finally, before starting the procedure, we wipe down the inside of the rectum with betadine to clear any residual debris and wipe down the wall of the rectum with an antiseptic.
Our treating physicians have completed an ACGME certified interventional radiology fellowship, part of which is training in the safe use of IV conscious sedation.
The American College of Radiology–Society of Interventional Radiology Practice Parameter for Sedation/Analgesia disagrees with your statement saying, “Patients who are ASA class I or II qualify for sedation/analgesia outside the operating room; ie, by personnel other than anesthesiologists.” ASA class I or II patients are those who are healthy or with mild systemic disease.
- Performing procedures with moderate sedation without an anesthesiologist present is a safe and accepted practice in the correct circumstances when performed under the supervision of a physician who has completed an ACGME accredited interventional radiology fellowship.
- Our physicians have performed hundreds of procedures with patients under moderate sedation (without an anesthesiologist present), including during complex procedures such as uterine fibroid embolizations, transarterial chemoembolizations for liver cancer, ultrasound guided liver microwave ablations, transjugular intrahepatic portosystemic shunt (TIPS) placement, MRI guided laser ablation for prostate cancer, MRI guided prostate biopsies, and more basic procedures such as port catheter or tunneled dialysis catheter placements.
- Having a properly trained physician experienced in conscious sedation and a very high quality registered nurse with significant critical care experience, good judgement, and appropriate certifications (e.g., ACLS, CSRN, etc) is critical. Nurse Donnie has these qualifications.
- Having high quality monitoring equipment including capnography (not required but very helpful) allows moderate sedation to be given even more safely.
- Having the fast acting, IV reversal agents immediately available, along with all the medications required for advanced cardiac life support, intubation equipment, a defibrillator, suction, etc. is both prudent and necessary in the rare event that a situation should arise.
“A nurse, doctor, or dentist, will give you conscious sedation in the hospital or outpatient clinic. Most of the time, it will not be an anesthesiologist.”
Another source (from the American Society of Anesthesiologists):
“An anesthesiologist or a registered nurse or nurse anesthetist working with a qualified physician may administer the sedation.”
What to Expect
Laser Focal Therapy for Prostate Cancer
Wondering what to expect before, during, and after your laser focal therapy for prostate cancer procedure? Take a look here.
 Urology Today. (2020). Outpatient trans-rectal MR-guided laser focal therapy phase II clinical trial: 10-year interim results video. Published online April 27, 2020
 Ficarra, V., Novarra, G., Rosen, R.C., et al. (2013). Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. European Urology, 63(3), 365-367. doi: https://doi.org/10.1016/j.eururo.2012.05.045
 Emanu, J.C., Avildsen, I.K., & Nelson, C.J. (2016). Erectile dysfunction after radical prostatectomy: Prevalence, medical treatments, and psychosocial interventions. Current Opinion in Supportive and Palliative Care, 10(1), 102-107. doi: 10.1097/SPC.0000000000000195
 Albkri, A., Girier, D., Mestre, A. et al. (2018). Urinary incontinence, patient satisfaction, and decisional regret after prostate cancer treatment: A French national study. Urologia Internationalis, 100, 50-56. doi: https://doi.org/10.1159/000484616
 Gaither, T.W., Awad, M.A., Osterberg, E.C. et al. (2017). The natural history of erectile dysfunction after prostatic radiotherapy: A systematic review and meta-analysis. The Journal of Sexual Medicine, 14(9), 1071-1078. doi: https://doi.org/10.1016/j.jsxm.2017.07.010
 Nair, S.M., Stern, N., Dewar, M. et al. (2020). Salvage open radical prostatectomy for recurrent prostate cancer following MRI-guided transurethral ultrasound ablation (TULSA) of the prostate: Feasibility and efficacy. Scandinavian Journal of Urology, 54(3), 215-219. doi: 10.1080/21681805.2020.1752795