Aquablation Provides Effective Treatment for LUTS in Men with Prostate Cancer: Study

A recent study published in the journal Urology found that Aquablation effectively improved urinary function and preserved or even enhanced sexual function in men with localized prostate cancer (PCa) and lower urinary tract symptoms caused by benign prostatic hyperplasia.

"The procedure did not lead to significant adverse events. Although a temporary rise in circulating tumor cells (CTCs) was noted right after the treatment, there were no oncological concerns, and CTC levels returned to normal within two days," the researchers wrote.

Jeremy Yuen Chun Teoh, S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, and colleagues conducted the study to assess the effect of Aquablation on circulating tumor cells in men with localized prostate cancer.

For this purpose, the researchers conducted a prospective study involving subjects with biopsy-positive mpMRI visible lesions (PIRADS ≥ 3) who underwent Aquablation. Ten-milliliter blood samples were collected before, during, and after the procedure to assess circulating tumor cell (CTC) counts using an immunofluorescence assay.

The investigation uncovered the following findings:

• The mean age of participants was 63.4 years, with a baseline PSA of 8.9 ng/ml and a prostate volume of 60.3 ml.
• All subjects showed reduced IPSS scores and stable or improved SHIM and MSHQ-EjD scores.
• Detectable circulating tumor cells were found in 80% of subjects before Aquablation, 100% immediately after, 20% on post-op day 2, and 60% on post-op day 7.
• The mean number of CTCs per patient in a 10 ml blood draw was 1.2 pre-operatively, 3.2 immediately post-op, 0.2 on day 2, and 1.0 on day 7.
• Prostate volumes significantly decreased at 3 and 6 months, with corresponding reductions in PSA levels.
• No adverse events were reported, including no instances of incontinence, erectile dysfunction, ejaculatory dysfunction, or rectal toxicity.
• At the 6-month follow-up, all baseline mpMRI lesions were no longer visible on mpMRI, and follow-up biopsies showed no grade group progression.

The study observed a reduction in IPSS symptom scores for all participants. It demonstrated that Aquablation does not significantly increase circulating tumor cells (CTCs) in men with localized prostate cancer undergoing treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). The transient rise in CTCs immediately following Aquablation aligns with existing literature on the effects of surgical manipulation of the prostate, with levels returning to baseline within a week. This transient CTC exposure is comparable to a few days of active surveillance.

"These findings support the use of Aquablation as an effective treatment for LUTS due to BPH in men on active surveillance, including those with known prostate cancer," the researchers concluded.

Reference:

Teoh, J. Y. C., Yuen, S. K. K., Lau, B. S. Y., Lai, F. P. T., Lee, K. L., Chiu, P. K. F., Yee, C. H., & Ng, C. F. (2025). Robotic Waterjet Resection for Men with Prostate Cancer Suffering from Lower Urinary Tract Symptoms. Urology. https://doi.org/10.1016/j.urology.2025.01.020