Aquablation as a treatment for prostate cancer trial

Overview by
Professor Richard Hindley
Consultant Urological Surgeon
Hampshire Hospitals NHS Foundation Trust

and by Mr Mark Rochester
Consultant Urologist
Norfolk and Norwich University Hospital NHS Foundation Trust

Aquablation, a water jet, which is currently used for treating men with enlarged prostates, is now part of a clinical trial using Aquablation to treat prostate cancer. The goal is to show that Aquablation is as effective as radical prostatectomy surgery but with much reduced side effects when it comes to erections, ejaculation and continence (uncontrolled peeing).

That is to have more of less the same outcomes as other focal therapies

To be selected for the trial you need to fit the following:

• Be  45 years old or older when you join the trial
• Have intermediate grade cancer with a Gleason score of 7 and cancer Stage up to T2c.

Learn more about what these mean by clicking the buttons below:

(links here to the Gleason and cancer staging pages)

•  A PSA of  20 ng/ml or less
• A mini9mum Prostate volume of 25 ml

If you are on the trial and have Aquablation, you will be monitored for 10 years to see if the cancer comes back.

In the short term, at 3 months you will be asked about

• How may pads you are using because or urinary incontinence
• Whether you can have erections and how good they are.

At 6 months you will be asked the same questions again as things should improve with time.

At one year you will have a PSA test and possibly an MRI to see if there is any sign of the cancer returning.

So what is Aquablation and what happens?

Aquablation treatment uses the ‘AquaBeam’ Robotic system.  The system uses real-time ultrasound scan images in combination with direct visualization to plan and deliver the treatment required to destroy and remove  the cancer lesions. The system uses a high-velocity sterile heat-free waterjet and autonomous robotics, pre-programmed by the Urologist, to remove  the cancerous tissue.

The pre-programming defines the angle of the probe and the depth and duration for firing the water jet.

The procedure is usually performed with the patient under general or spinal anaesthesia. Whilst the ablation (cancer tissue removal) time is usually less than 10 minutes, the set up and real time ultrasound guided planning mean that the whole procedure takes about 45 minutes. At the end of the procedure, focal “bladder neck cautery” with a diathermy loop  is used to stop bleeding. Once the procedure is complete a 3-way Foley catheter is placed through the penis into the urethra to ‘irrigate’ the bladder. The catheter is usually removed the next day and the patient is typically discharged from hospital once urine has been passed in an adequate fashion, although for some patients, the procedure is now done as a daycase, with the catheter removed at home or in a clinic after 24-48 hours.

If you are interested in being treated with Aquablation, the next page tells you the hospitals involved in the trial and whom to contact at each of them.

Editors note from Marcus Clark

Remember this a  clinical trial comparing Aquablation to radical prostatectomy and you will be randomly assigned to receive one of those two treatments.

Remember, you can always refuse to have a radical prostatectomy and ask to be referred to a hospital offering focal therapy