Focal Therapy for Prostate Cancer – PROFOCAL Laser therapy

Not covered by Medicare / Health Fund yet. Only used in trial settings currently.

AUSTRALIAN DESIGN AND MANUFACTURED

What is ProFocal

• ProFocal is a minimally invasive focal laser treatment used for localized prostate cancer.
• The procedure uses a needle-guided laser system to deliver energy directly to the tumor, with the goal of preserving healthy tissue and function,
• It may lead to a faster recovery with minimal side effects like urinary incontinence or erectile dysfunction. 

Seen here is a similar product used in USA. THIS IS NOT ProFocal. I am attempting to demonstrate the principle.

Why is it done?

• Treatment for localized prostate cancer
• Single focus disease
• Prostate preserving
• Ejaculate sparing
• Continence preserving

How is it done?

• Focal therapy of prostate cancer, usually a single lesion
• Any Gleason grade, not Gleason 6 as this can be managed with surveillance
• Preserving prostate supporting tissue and erectile function and continence

You would have had a 3T MRI study possibly a PET PSMA as well prior to confirming your prostate cancer. Usually, whole gland biopsies are taken of the prostate via the perineum to prove unifocal cancer.

• This procedure is done under general anesthesia as a day procedure and takes approximately 60-90min (incl anesthetic time)
• It is performed with the patient lying in lithotomy position
• Prophylactic antibiotics are provided with anesthesia.
• Planning would be done as to where needles should be placed to provide a 1cm coverage beyond the tumour using your MRI as guidance.
• A trans-rectal ultrasound is placed
• Laser probe is inserted via a trans perineal needle with ultrasound guidance
• Treatment delivered
• Needle removed and placed 5-7 mm adjacent to previous needle with next treatment delivered

Complications

Side–effects

• Hematuria (blood in urine) 2-3days
• Hematospermia (blood in ejaculate) will become less the more often you ejaculate.
• Bacteremia (infection) with low-grade fever and feeling unwell
• Perineal hematoma
• Perineal pain and penis tip pain
• Prostate swelling causing bladder outlet obstruction requiring a catheter for up to 5 days

ANY FEVER REQUIRES URGENT ATTENTION

What next?

• You will be discharged after a trial without catheter
• You may have necrotic tissue developing requiring a resection (treatment involving the urethra).
• Difficulty in urination up to 6 weeks after the procedure
• It could feel like you are sitting on a golf ball for a week
• Continence and erectile function should not be affected

Should there be any signs of fever or cold shivers, you are to return to the hospital or Emergency Department without hesitation

Download Information Sheet

Wes ProFocal

Copyright 2019 Dr Jo Schoeman