Minimally Invasive Ablative Treatment for Prostate Cancer

Minimally invasive ablative treatment is a relatively new and evolving treatment option for prostate cancer at NYU Langone. It uses laser, radiofrequency, high-intensity focused ultrasound, or cryotherapy (extremely cold temperatures) to ablate, or destroy, part or all of the prostate, thereby eliminating the cancer. NYU Langone doctors are pioneers in the use of lasers, radiofrequency, and high-intensity focused ultrasound (HIFU) for prostate ablation.

In laser therapy, a laser fiber, guided by MRI scanning, destroys cancer cells in the prostate. In radiofrequency ablation, a probe that is inserted into the prostate destroys selected tissue using heat created by high-frequency radio waves. In high-intensity focused ultrasound, targeted sound waves create focused heat energy that destroys only selected tissue. In cryotherapy, controlled freezing and thawing of the prostate gland destroys cancerous cells and other cells in the targeted area.

Doctors at NYU Langone’s Smilow Comprehensive Prostate Cancer Center may consider minimally invasive ablative treatments as a secondary treatment, used when radiation therapy fails to eradicate prostate cancer. It can be used to destroy the whole gland as an alternative to prostatectomy surgery or just the cancerous portion of the prostate—what’s known as focal ablation.

Focal Ablation

If cancer is located in only a small area of the prostate, your doctor may perform focal gland ablation in order to eliminate the cancer while sparing the rest of the prostate. This approach helps to minimize the 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.

NYU Langone doctors may recommend focal ablation when diagnostic tests, such as MRI scans and biopsy, have shown that the cancer could benefit from treatment and is located only in a specific region of the prostate. MRI imaging plays a critical role in helping specialists to determine if you are a candidate for focal ablation.

Doctors may use laser, radiofrequency, high-intensity focused ultrasound, or cyrotherapy for focal ablation. Your doctor can help you to weigh the risks and benefits of each type of focal ablation and develop a plan to monitor you at regular intervals after treatment to ensure the cancer has not returned.

High-intensity focused ultrasound, or HIFU, is one of the newest ablative technologies available, and NYU Langone was the second academic medical center in the United States to perform a HIFU ablation. Today, NYU Langone is one of the only medical centers in the country and the only one in the Northeast to offer HIFU.

During the procedure, doctors direct focused sound wave energy directly to the tumor under real-time ultrasound imaging guidance. They 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 high-intensity focused ultrasound, a catheter, 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 everyday activities, including sexual activity.

Depending on the type of energy used—laser, radiofrequency, high-intensity focused ultrasound, or cryotherapy—this procedure may be performed using local or general anesthesia and typically takes one to two hours. You typically leave the hospital the same day.

Whole-Gland Ablation

The goal of whole-gland ablation is to completely eliminate the cancer-containing prostate gland. At NYU Langone, 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 as an alternative to surgically removing the prostate.

In this procedure, a surgeon inserts several cryoprobes into the prostate in a very controlled fashion to freeze the prostate tissue. Performed using general anesthesia, the procedure typically lasts one hour. You may go home the same day, though some men stay overnight at the hospital.

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 pass within weeks. Long-term side effects include urethral strictures—a condition in which scar tissue in the urethra blocks the flow of urine—and erectile dysfunction.

More Prostate Cancer Resources