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Minimally Invasive Ablation Treatment for Prostate Cancer
Minimally invasive ablation for prostate cancer is a relatively new and evolving treatment option for prostate cancer at NYU Langone’s Perlmutter Cancer Center. It uses radiofrequency, high-intensity focused ultrasound (HIFU), or cryotherapy (extremely cold temperatures) to ablate, or destroy, part or all of the prostate—thereby eliminating the cancer.
In radiofrequency ablation, a probe inserted into the prostate destroys selected tissue using heat created by high-frequency radio waves. In HIFU, targeted sound waves create focused heat energy that destroys only selected tissue. 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.
Our experts may consider minimally invasive ablation treatments when radiation therapy fails to eradicate prostate cancer. It can be used to destroy the whole gland as an alternative to salvage prostatectomy surgery—surgery to remove remaining or recurring cancer—or just the cancerous portion of the prostate, which is known as partial gland ablation, focal ablation, or focal therapy.
Our doctors pioneered prostate ablation using radiofrequency and HIFU.
Partial Gland Ablation
If cancer is located in only a small area of the prostate, your doctor may perform partial gland ablation, or focal ablation, to eliminate the cancer while sparing the rest of the prostate. This approach minimizes 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 and our outcomes for the procedure are among the best nationwide.
We are among the few cancer centers in the United States to perform partial gland ablation, which eliminates cancer while sparing the rest of the prostate.
Our doctors may recommend partial gland ablation when diagnostic tests such as MRI scans and biopsy have shown that the cancer could benefit from treatment and is located in only a specific region of the prostate. MRI plays a critical role in helping specialists determine whether you are a candidate for partial gland ablation.
Research performed by our urologists has shown that following specific criteria to identify qualified candidates for partial gland ablation helps keep doctors from missing aggressive cancer cells in the prostate.
Doctors may use radiofrequency, HIFU, or cryotherapy for partial gland ablation. 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.
We were the first academic medical center in the Northeast to offer HIFU ablation, which allows doctors to apply focused sound wave energy, guided by real-time ultrasound imaging, directly to the prostate tumor.
During HIFU, doctors direct focused sound wave energy directly to the tumor, using ultrasound at the same time as a guide. 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.
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 is extremely rare after cryoablation, and sexual function is often preserved.
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.
Depending on the type of energy used—radiofrequency, HIFU, or cryotherapy—partial gland ablation may be performed using local or general anesthesia and typically takes one to two hours. You leave the hospital the same day.
Your doctor may recommend a prostate-specific antigen, or PSA, test and an MRI scan six months after partial gland ablation. If at that point your PSA score is high, your doctor may also recommend a biopsy.
We currently recommend that all men receive an MRI and prostate biopsy two years following partial gland ablation.
The goal of whole gland ablation is to completely 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 as an alternative to surgically removing the prostate to treat localized prostate cancer.
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 one hour. You may go home the same day, though some men stay overnight in 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 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.
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