If you are diagnosed with early-stage prostate cancer, you usually have three treatment choices: monitoring (called active surveillance), surgery, or radiation therapy. Whole-gland ablation is an alternative to these treatments.
Ablation uses strong cold or heat to burn or freeze prostate cancer. Partial or focal gland ablation treats only the small area of the prostate gland where the cancer is located. Whole-gland ablation destroys all of the prostate tissue.
Whole-gland ablation is a less-invasive option if you have small or less aggressive cancers and can't have surgery or radiation therapy, or you don’t want these treatments. Unlike surgery, ablation doesn't involve any cuts or stitches. And it can be done again if you still have cancer cells left in your prostate after treatment.
Like other prostate cancer treatments, whole-gland ablation has some risks you should know about. Your doctor will explain the procedure and help you decide whether it's a good fit for you.
When Would You Have This Treatment?
Most doctors don't use whole-gland ablation as the first treatment for prostate cancer. But it can be another option to surgery or radiation therapy for early-stage prostate cancer that hasn't spread outside of the prostate gland.
You might prefer ablation because it may cause fewer sexual and urinary side effects than surgery. One study showed that African-American men preferred cryoablation to surgery because it is less invasive.
Your doctor might also consider ablation if your prostate cancer didn't respond to radiation therapy or the cancer came back after radiation treatment.
How It Works
Whole-gland ablation delivers intense heat or cold to your prostate gland. Your doctor will talk to you about which type of procedure is better for you.
You will get medicine before ablation to make you sleep and prevent pain. During the procedure, you will lie on your back with your legs raised above your hips and your knees bent.
High-Intensity Focused Ultrasound (HIFU)
This treatment uses sound waves to heat prostate tissue to very high temperatures. The heat kills cancer cells.
A small ultrasound probe goes into your rectum. The probe sends an image of your prostate to a video screen so your doctor can see to perform the procedure. That same probe releases heat to destroy the tumor.
Cryoablation
This treatment uses very cold temperatures to kill cancer cells. The doctor inserts a few hollow needles called cryoprobes through the perineum – the skin between your scrotum and rectum – and into your prostate. Another probe sends a picture of your prostate to a video screen so your doctor can see where to place the needles.
Very cold gas travels through the probes to your prostate. The gas freezes and destroys prostate tissue. This treatment damages cancer cells without harming healthy tissues around your prostate.
What to Expect After Ablation
Ablation is often done as a same-day procedure, but you may need to stay overnight in the hospital.
Your prostate will be swollen for a few days after ablation, and it will be hard for urine to pass through your urethra. A thin tube called a catheter placed into your urethra during the procedure will help urine leave your body. Your doctor will remove the catheter about 7 days after the procedure, once the swelling in your prostate has gone down.
You should be able to do moderate activities like walking within a day or two after the procedure. Wait to do more intense exercise until the catheter comes out.
How Effective Is It?
Whole-gland ablation can be an effective treatment for prostate cancer that hasn't spread. The 5-year survival rate after whole-gland HIFU is around 100 percent. In most people, the cancer doesn't spread again during that time. But some need more than one treatment to wipe out all of their cancer cells.
In people with low-risk prostate cancer, whole-gland ablation is just as effective as surgery. But the procedure and recovery times are shorter with ablation than with surgery.
Partial-gland ablation might be a better option for some than whole-gland ablation. Both procedures have similar results, but whole-gland ablation takes longer to perform, has a longer recovery time, and causes more side effects than partial-gland ablation.
Whole-gland ablation isn't recommended if you have high-risk prostate cancer. High-risk means you have a Gleason score of 8-10 or a prostate-specific antigen (PSA) score above 20. Treatments like surgery and radiation are better for controlling these more aggressive cancers.
The Risks
Whole-gland ablation can cause side effects. Your doctor should go over these risks with you before the procedure.
The most common side effects are:
- Pain or burning when you pee
- Incontinence, or trouble controlling urine
- Trouble getting an erection
- Bruising and swelling in the scrotum
- Fluid leaking from the urethra
- An urge to pee more often than usual
These side effects should clear up within a few weeks after your surgery. Rarely, you may develop strictures – narrowing of the urethra caused by scar tissue.
Other Treatment Options
If you have low-risk, early-stage prostate cancer, you may have one of these treatments instead:
Active surveillance. Prostate cancer often grows very slowly. Active surveillance is when you wait to start treatment. Your doctor will closely monitor your cancer with PSA blood tests, digital rectal exams (DREs), biopsies, and imaging tests.
Radiation therapy. This treatment uses high-energy rays to kill cancer cells. External-beam radiation delivers these rays from a machine outside your body. Brachytherapy places tiny radiation seeds inside your prostate.
Radical prostatectomy. This surgery removes the whole prostate gland, along with some of the tissue around it.
Radiation and surgery are also treatments for late-stage, high-risk prostate cancers. Hormone therapy is often added to radiation. Also called androgen suppression therapy, hormone therapy cuts off the hormones prostate cancer needs to grow.
Choosing a prostate cancer treatment is a big decision. Whole-gland ablation can be an alternative to surgery and radiation if you have a small and slow-growing tumor. Talking through all of your options with your doctor to find the one that offers you the most benefits with the fewest risks.
