Hydroablation Device Shows Promise for Early Prostate Cancer

  • A hydroablation device for benign prostatic hyperplasia showed promise as a potential treatment aid for early prostate cancer in a small Chinese study.
  • The proportion of patients with detectable circulating tumors cells increased immediately after treatment, then declined to below pretreatment numbers.
  • Prostate symptoms improved, sexual function was preserved, and MRI showed no prostate lesions at 6 months

A hydroablation device developed for benign prostatic hyperplasia (BPH) showed promise as a potential treatment aid for early prostate cancer, according to results of a preliminary study from China.

Men in active surveillance for prostate cancer with symptomatic lower urinary tract symptoms (LUTS) had an early spike in circulating tumors cells (CTCs) after treatment, followed by a decrease to below baseline levels. MRI-detected prostate lesions had disappeared 6 months after Aquablation treatment.

In addition, prostate symptoms improved and sexual function remained stable or improved, reported Jeremy Yuen Chun Teoh, MD, of the Prince of Wales Hospital and the Chinese University of Hong Kong, and co-authors in Urology.

“In an active surveillance population, Aquablation resulted in improved urinary function, stable or improved sexual function, and a transient spike in CTCs lasting less than 2 days that did not result in any oncologic concern,” the authors noted. “Aquablation may be considered a safe option for men with localized prostate cancer who require treatment for LUTS due to BPH.”

Noting that the study involved only five patients, the authors of an accompanying editorial nonetheless were impressed by the results and called for further investigation of the hydroablation device in prostate cancer.

“While the significance of CTCs remains debatable, these results suggest that Aquablation among this cohort does not worsen oncologic symptoms,” wrote Greg Raster, MD, of the University of Chicago, and Brian T. Helfand, MD, of Endeavor Health in Evanston, Illinois. “Rather, Aquablation appeared to also eliminate MRI lesions in all patients, suggesting this therapy may also be a suitable treatment for these types of cancer patients. The data support further exploration into this exact question, whether Aquablation can be used as treatment for both BPH and prostate cancer.”

“If Aquablation ultimately becomes a viable treatment for prostate cancer, it would be different from almost all other focal therapy,” Raster and Helfand added. “Specifically, Aquablation has the potential to treat increasing amounts of tissue bilaterally within the prostate without a proportional increased risk in side effects. Taken together, this makes Aquablation a very attractive candidate for this dual purpose.”

The Aquablation system initially received FDA approval in 2017 for treatment of LUTS secondary to BPH. The FDA cleared the artificial intelligence-assisted robotic Hydros system for water ablation last year. The system uses a high-intensity waterjet to remove tissue, as compared with other technologies that ablate tissue in situ, Teoh and colleagues noted in their introduction.

A theoretical concern is the potential for spillage of CTCs.

“Any physical manipulation of the prostate, be it digital rectal exam, biopsy, surgery, TURP [transurethral resection of the prostate], or enucleation, has the theoretical potential to cause tumor cells to shed for a transient period of time,” the study authors wrote. “The magnitude of actual CTC release is minute and inconsequential in comparison to the integral release of naive localized prostate cancer and there is a substantial body of evidence supporting the lack of metastatic risk posed by physical diagnostic or treatment manipulation of the prostate.”

A recent meta-analysis of 12 studies involving a total of 1,917 men with prostate cancer showed no significant association between pretreatment levels of primary CTCs and biochemical recurrence. Teoh and colleagues conducted a pilot study to determine whether Aquablation could lead to metastatic seeding by means of CTCs released into the circulation.

The five patients enrolled in the trial had a mean age of 63.4, a baseline prostate-specific antigen (PSA) level of 8.9 ng/mL, and a mean prostate volume of 60.3 mL. All of the men had visible prostate lesions by multiparametric MRI (grade group 1) and were considered candidates for active surveillance. They also had LUTS, with an International Prostate Symptom Score (IPSS) of 18.2. Treatment was by robotic-assisted bilateral hydroablation of the prostate. The primary outcome was CTC counts in serial blood sample draws.

Four patients had detectable CTCs before treatment. All five had detectable CTCs immediately after treatment, two had detectable CTCs on post-treatment day 2, and three on day 7. The CTC count per patient was 1.2, 3.2, 0.2, and 1.0 on the four assessment days. Prostate volume decreased to a mean of 37.1 mL at 3 months and was 37.8 mL at 6 months (P<0.05 vs baseline). PSA level declined to 4.6 ng/mL at 3 months (P<0.01) before rebounding slightly to 5.6 ng/mL at 6 months (P<0.05 vs baseline).

The investigators observed no disease progression by MRI, and none of the patients had visible prostate lesions at the 6-month assessment by MRI. Three patients had negative prostate biopsies, and two had grade group 1 disease.

The mean IPSS score decreased to 8.2 at 3 months and was 9.2 at 6 months. Sexual function assessments showed no significant change or improvement from baseline at 3 and 6 months.

The FDA has approved a pivotal randomized clinical trial to compare Aquablation and radical prostatectomy in men with grade group 1-3 localized prostate cancer.

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    Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow

Disclosures

The study was supported by Procept BioRobotics.

Teoh disclosed a relationship with Procept BioRobotics.

Helfand disclosed a relationship with Procept BioRobotics.

Raster reported no relevant relationships with industry.

Primary Source

Urology

Source Reference: Teoh JYC, et al “Robotic waterjet resection for men with prostate cancer suffering from lower urinary tract symptoms” Urology 2025; DOI: 10.1001/j.urology.2025.01.020.

Secondary Source

Urology

Source Reference: Raster G, Helfand BT “Aquablation safety and outcomes among men with prostate cancer” Urology 2025; DOI: 10.1016/j.urology.2025.01.058.

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