71-year-old male with Gleason 6/7 prostate cancer. Patient was administered prophylactic intravenous gentamycin prior to the procedure. Following the discussion of the risks (bleeding, infection, pain, soft tissue injury, incontinence, impotence), benefits, and alternatives of the procedure. Informed consent was obtained from the patient. The procedure was performed under moderate conscious sedation with nurse monitoring.The MRI focus in the left mid peripheral zone suspicious for patient's known cancer was localized with T2 weighted MR images. Following sterile preparation, Visualase laser ablation template was placed on to the perineum of the patient and localized on MR images and registered to the MR images where the prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were inserted into the left side of the prostate. Upon confirmation of the tip of the needle in the region of the known lesion, 6 laser ablations (3 sites, 2 depths per site) with 30-W, 90 % power were performed within the left mid peripheral zone of the prostate. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images were obtained before and after administration of 16 ml of MultiHance, upon completion of the procedure. The non-enhancing ablation defect was noted, centered in the left posterior lateral quadrant of the mid gland at the site of prior lesion, but also extending to the left apex and base. Edema was seen within the left aspect of the prostate and periprostatic tissues, corresponding to lidocaine. COMPLICATIONS: NoneBLOOD LOSS: 5 ml
MR guided laser ablation of the left mid gland peripheral zone of the prostate at the site of the previously described suspicious focus.PLAN: The patient was subsequently transferred to the recovery room for nurse monitoring. The patient will be discharged after voiding or with a Foley catheter. The patient will follow-up with urology.