Partial gland ablation in the management of prostate cancer: a review

The index lesion theory has created a strong interest in partial gland ablation for men with prostate cancer. By only treating the focus of clinically significant disease and avoidance of surrounding periprostatic tissue, one may provide adequate oncologic control with minimal side effects. Accurate identification of the index lesion and effective ablation are critical for satisfactory oncologic outcomes. Herein, we review key ablative techniques used in partial gland ablation.

Increasing accuracy in identifying localized prostate cancer enabled the emergence of partial gland ablation, which appears to have acceptable short-term oncologic control with minimal side effects. Cryoablation, high-intensity focused ultrasound, focal laser ablation, and irreversible electroporation are emerging technologies that are demonstrating their utility in partial gland ablation. These different ablative techniques offer unique advantages and drawbacks in partial gland ablation of prostate cancer.

Prostate imaging continues to scale the challenge of accurately identifying clinically significant prostate cancer. Ablative techniques demonstrate acceptable short-term oncologic outcomes but will require longer follow-up to determine true oncologic efficacy. There are no randomized trial comparisons to conventional radical prostatectomy or radiotherapy, and there is limited oncologic follow-up beyond 5 years. The type of ablation technique used will likely depend on many factors such as tumor volume, tumor location, and patient characteristics. Oncologic efficacy, health-related quality of life, and advantages and limitations of each technique will be reviewed.