Focused Laser Ablation: New Treatment for Enlarged Prostate

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A procedure called focused laser ablation (FLA) has been approved by the Food and Drug Administration for treatment of prostate cancer, yet Dr. Dan Sperling has adapted that approach and used it for men with BPH (benign prostatic hyperplasia) with great success. Although focused laser ablation for BPH is not yet widely available, chances are good it will be climbing the chart of effective, safe, and desirable treatments for BPH.

What is focused laser ablation?

Focused laser ablation for BPH uses a combination of magnetic resonance imaging (MRI) and laser (electromagnetic radiation) to effectively treat an enlarged prostate in a single session. After the patient receives a local anesthetic, he is slid into an MRI tunnel, where clinicians use real-time 3T multiparametric MRI to identify the exact location where the enlargement is squeezing the urethra.

Once the treatment site is located, the surgeon threads a hollow needle guide through the rectum to the prostate. Then he or she passes a laser fiber optic through the guide and activates the laser for two to three minutes to reduce the tissue. The process is known as debulking because the laser reduces the bulky enlarged prostate tissue.

During FLA, special software monitors the prostate tissue temperature to ensure no damage occurs. Once the laser treatment is complete, the MRI is used to make sure all the involved tissue has been removed. Patient anatomy differs from one man to another. Depending on the size of the gland at the time of treatment, and the extent and degree of laser power, some patients will be discharged wearing a catheter. Patients typically can go home immediately following the treatment.

What are the side effects of focused laser ablation for BPH?

Unlike other procedures to treat BPH, focused laser ablation does not involve reaching the prostate via the urethra. Therefore, men do not experience the side effects associated with compromising the urethra, such as erectile dysfunction, retrograde ejaculation, and urinary incontinence. Some men experience a small amount of blood in their urine as the prostate heals.

What makes focused laser ablation for BPH so successful?

Focal laser ablation for BPH is able to permanently relieve symptoms of an enlarged prostate because the laser coagulates rather than vaporizes the excess tissue.

The laser does not touch the urethra but instead causes targeted prostate tissue to shrink by generating harmless scar tissue that the body then reabsorbs over a period of a few weeks and BPH symptoms diminish. Since no dead tissue ends up in the urethra, there is no chance for urinary blockage after the procedure.

Dr. Sperling decided to adapt the focused laser ablation technique for prostate cancer to help men with BPH after he learned that patients who had undergone FLA for cancer reported that their BPH symptoms had resolved. He reported that “Because treatment [FLA for BPH] is outside the urethra, I’m not affecting that delicate lining. I’m simply debulking the tissue that’s causing pressure on the urethra.” The result appears to be an effective way to eliminate BPH symptoms with no significant side effects.

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