CPT® Code 0655T

Transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with MR-fused images or other enhanced ultrasound imaging

Transperineal focal laser ablation (FLA) is a specialized medical procedure designed for the targeted destruction of malignant prostate tissue. This technique utilizes focused laser energy to thermally ablate cancerous cells while preserving the surrounding healthy prostate tissue. The procedure is characterized as minimally invasive, allowing it to be performed on an outpatient basis, which typically results in a lower risk of side effects compared to more traditional surgical methods. FLA can be repeated if necessary, providing flexibility in treatment options for patients. During the procedure, the malignant tissue absorbs the laser light energy, which induces heat within a matter of seconds, leading to the destruction of the targeted cells. The effectiveness of the procedure is influenced by several factors, including the temperature, duration of heat transfer, and the depth of light distribution, all of which are determined by the specific wavelength of the laser used. To facilitate the procedure, a Foley catheter is placed, and an ultrasound probe is inserted into the rectum, usually under intravenous sedation combined with a local anesthetic. A percutaneous catheter is then inserted through the perineum to deliver an optical fiber equipped with a diffusing tip and a diode laser, which is surrounded by a cooling system connected to a flow circuit of sterile saline at room temperature. The precise location of the cancerous tissue is identified using contrast-enhanced ultrasonography or three-dimensional ultrasound, guided by MRI-fused images. Initially, the laser is activated at a lower power level to confirm the correct placement before the full treatment begins. Throughout the procedure, real-time monitoring of tissue necrosis and temperature around the treatment area is conducted to ensure safety, with the system programmed to terminate laser delivery if critical structures reach predetermined temperature limits. After the procedure, the Foley catheter is removed, and the patient is monitored for a period before being discharged.