Prostate Cancer Aquablation (PCAq): A Novel Technique for Subtotal Resection of Prostate

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How to cite: Helfand BT. “Prostate Cancer Aquablation (PCAq): A Novel Technique for Subtotal Resection of Prostate.” Grand Rounds in Urology. October, 2025. Accessed

. https://grandroundsinurology.com/prostate-cancer-aquablation-pcaq-a-novel-technique-for-subtotal-resection-of-prostate/

Summary

Brian T. Helfand, MD, PhD, Chief of Division of Urology, Associate Chief Scientific Officer, Clinical Professor, NorthShore University Health System, University of Chicago, Evanston, Illinois, presents emerging data on prostate cancer aquablation. He notes that aquablation is established for benign prostatic hyperplasia (BPH) and provides symptom relief with preservation of ejaculatory and erectile function. He extends this discussion to prostate cancer and outlines how aquablation may offer an intermediate option that provides cancer control while maintaining quality of life.

He explains that prostate cancer is often multifocal and that prostate cancer aquablation functions not as focal therapy but as a resection. He shares that the water jet technology can reach both the transition and peripheral zones and can remove more than ninety-five percent of prostate tissue while preserving the true capsule. He describes published work showing that aquablation does not increase circulating tumor cells and that transient increases during procedures are significantly lower than those observed with radical prostatectomy.

Dr. Helfand outlines procedural principles and states that prostate cancer aquablation typically involves multiple passes to remove anterior tissue and peripheral zone tissue. He describes single-center data comparing men with BPH only versus men with BPH and prostate cancer and reports that symptom improvement is similar across groups. He then compares cancer outcomes to active surveillance and notes a significant reduction in Grade Group progression among aquablation patients.

He presents early data from two ongoing trials that include mostly intermediate-risk patients with peripheral zone disease and reports low transfusion rates, preservation of erectile function, low incontinence rates, and minimal early upgrading. He also discusses an ongoing randomized WATER4 trial comparing aquablation to prostatectomy, focusing on treatment-related harm.

Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.