Laser interstitial thermal therapy

Prostate cancer (PCa) continues to be the leading non-cutaneous cancer in men in the United States and responsible for nearly 30,000 deaths and 230,000 new cases per year. The widespread use of prostate-specific antigen (PSA) testing has led to an overall increase in the proportion of men diagnosed with low-risk disease with concurrent decrease in disease-specific mortality. According to the Surveillance, Epidemiology, and End Results (SEER) database, the advent of PSA screening in 1987 has since resulted in approximately a sevenfold increase in PCa incidence when compared to the pre-PSA era. The increased detection of low-risk disease has also corresponded to a greater proportion of men diagnosed with PCa undergoing radical prostatectomy (RP) or radiation therapy (RT). The complications associated with these procedures such as urinary incontinence (20 % for RP and 5 % for RT) and erectile dysfunction (64 % for RP and 66 % for RT) in many cases outweigh the benefits. The European Randomized Study of Screening for Prostate Cancer (ERSPC) trial also found that approximately half of those who underwent surgery were found to have cancers that were defined to be clinically indolent (<0.5 cm tumor volume, organ-confined, Gleason score ≤6). Active surveillance (AS) has been an appealing alternative for managing low-risk disease, but concerns have been raised regarding potential decreases in long-term survival rates.