From the Guidelines
Prostate ablation should be considered in select patients with intermediate-risk prostate cancer, as it offers a potential middle-ground approach between active surveillance and radical treatments, with the ability to preserve urinary and sexual function while effectively treating the condition. When considering prostate ablation, it is essential to weigh the potential benefits and risks, including the impact on morbidity, mortality, and quality of life. According to the most recent and highest quality study 1, prostate ablation may be considered in select, appropriately informed patients with intermediate-risk prostate cancer. The study highlights that patients with low-risk prostate cancer should be managed with surveillance, while those with high-risk disease should not be recommended for whole gland or focal ablation outside of a clinical trial.
Key Considerations
- Prostate ablation is a minimally invasive procedure that uses energy sources to destroy targeted prostate tissue while minimizing damage to surrounding structures.
- The procedure can be effective in treating localized prostate cancer and moderate to severe BPH symptoms not responding to medication.
- Potential side effects include temporary urinary symptoms, erectile dysfunction, and rarely, urinary incontinence.
- Follow-up typically includes PSA monitoring and imaging to assess treatment success.
Recommendations
- Patients being considered for ablation should have intermediate-risk prostate cancer, as there is a lack of data supporting treatment of high-risk disease with ablation.
- Clinicians should not recommend whole gland or focal ablation for patients with high-risk prostate cancer outside of a clinical trial 1.
- Active surveillance is the preferred approach for patients with low-risk prostate cancer.
- Prostate ablation may be considered in select patients with intermediate-risk prostate cancer, with clinical trial enrollment prioritized.
From the Research
Prostate Ablation Overview
- Prostate ablation is a minimally invasive treatment for localized prostate cancer (PCa) that uses various energy sources to destroy cancer cells.
- Studies have shown that prostate ablation is a safe and effective treatment option for patients with primary PCa, with low rates of complications and good functional outcomes 2, 3, 4.
Treatment Options
- High-intensity focused ultrasound (HIFU) is a non-invasive treatment option that uses ultrasound waves to heat and destroy cancer cells 4, 5.
- Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation (TULSA) is a minimally invasive treatment that uses real-time MR thermometry feedback to target prostate disease 2.
- Focal laser ablation (FLA) is a minimally invasive treatment that uses laser energy to destroy cancer cells, guided by multiparametric magnetic resonance imaging (mpMRI) 6.
Efficacy and Safety
- Studies have shown that prostate ablation is effective in reducing prostate-specific antigen (PSA) levels and improving cancer-specific survival rates 2, 3, 4.
- The rate of salvage treatment after one TULSA treatment for primary PCa was 7% to 17% 2.
- The rate of biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 years were 58%, 96%, 63%, 71-79%, and 84%, respectively 3.
- Complication rates were low, with grade III adverse events incurred by 6% of patients 2 and no rectal injury/fistula or Grade IV complication.
Functional Outcomes
- Continence and potency preservation were high, with rates of 92% to 100% and 75% to 98%, respectively 2.
- Urinary symptoms were stable in men with good voiding function at baseline, and 85% of men with concurrent PCa and lower urinary tract symptoms met the criteria for improvement 2.
- Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8% 3.