Minimally Invasive Ablation Treatment for Prostate Cancer

Focal therapy, also known as focal ablation or partial-gland ablation, destroys only the portion of the prostate that contains cancer cells. It is typically done as an outpatient procedure, and typically has fewer side effects than other options. It also has fewer complications in general, preserving more functioning of the prostate gland.

Whole-gland ablation, which destroys the entire prostate gland, can be used as an alternative to salvage prostatectomy surgery, which is done to remove remaining or recurring cancer, which may occur after radiation therapy, for instance.

In cryotherapy, the form of ablative therapy most often used by NYU Langone doctors, controlled freezing and thawing of the prostate gland destroys cancerous cells and other cells in the targeted area. In HIFU, targeted sound waves create focused heat energy that destroys only selected tissue.

If cancer is in only a small area of the prostate, your doctor may perform focal therapy to eliminate the cancer while sparing the rest of the prostate. This approach minimizes side effects associated with removing the prostate, including urinary incontinence and erectile dysfunction. NYU Langone is among the few medical centers in the country where this therapy is performed, and our outcomes for the procedure are among the best nationwide.

Our doctors may recommend focal therapy when diagnostic tests such as MRI scans and biopsy show that it is likely to be an effective treatment. When cancer is in only a limited portion of the prostate, it is a good candidate for focal therapy.

Focal therapy may also be used after radiation therapy, if prostate cancer should reoccur. This allows treatment while also minimizing potential side effects.

Doctors at NYU Langone use cryotherapy or HIFU for focal therapy. Your doctor can help you weigh the risks and benefits of each type of ablative energy and develop a plan to monitor you at regular intervals after treatment to ensure the cancer has not returned.

Focal therapy is typically performed using general anesthesia. It typically takes one to two hours, and you leave the hospital the same day.

Using Cryotherapy Ablation for Focal Therapy

During cryotherapy ablation, doctors insert probes that freeze tissue and monitor temperature in and around the prostate. The cryotherapy probes deliver temperatures often colder than −100 degrees Celsius to destroy cancer cells. Doctors use the temperature probes, along with ultrasound, to guide them and protect the rectum, bladder, sphincter, nerves, and veins from damage. Incontinence after cryoablation is an extremely rare side effect, and sexual function is often preserved.

Using High-Intensity, Focused Ultrasound for Focal Therapy

High-intensity, focused ultrasound (HIFU) uses sound wave energy applied directly to the tumor, using ultrasound at the same time as a guide. Specialists also use computer software and prior MRI scans to determine how much ablation is needed. This helps doctors destroy the cancerous tissue while preserving surrounding healthy structures.

After HIFU or cryotherapy, a catheter, which is a slender tube, is used to divert urine out of the body, allowing the prostate to heal. Your doctor removes the catheter a few days later. Once it is removed, you can resume normal activities, including sexual activity.

The goal of whole-gland ablation is to eliminate the cancer-containing prostate gland. Our doctors most often use whole-gland ablation to treat men after radiation therapy fails to eliminate prostate cancer. The most common type is cryoablation, which uses argon gas to freeze prostate tissue.

Because whole-gland ablation can cause side effects and doesn’t cure prostate cancer as reliably as surgery, our specialists believe that whole-gland ablation should be used rarely. It may be used as a first-time treatment, as an alternative to surgically removing the prostate to treat localized prostate cancer, and also when prostate cancer reappears after radiation therapy.

In this procedure, a surgeon inserts several cryoprobes into the prostate to freeze the prostate tissue in a very controlled fashion. Performed using general anesthesia, the procedure typically lasts two hours, and patients go home the same day.

A catheter may be used to divert urine out of the body and allow time for the body to heal after the procedure. The catheter is removed by your doctor about a week later.

Side effects of this procedure can include discharge from the urethra, swelling of the scrotum, pain or burning during urination, and fatigue. These generally disappear within weeks. Long-term side effects may include urethral strictures—a condition in which scar tissue in the urethra blocks the flow of urine—and erectile dysfunction.