Video: What is Prostate Aquablation? | Off the Cuff With Mark Moyad, MD, MPH & Steven Gange, MD

Off the Cuff With Mark Moyad, MD, MPH | Transcription

Dr. Moyad: Uh, did I miss anything in the BPH category or something else I'm missing that's happening in BPH that's exciting that I'm not putting my finger on here today? 

Dr. Gange: Well, there is one other recently approved therapy. It's called aquablation. So aquablation is essentially a robotically guided water pick into the prostate. This is a procedure done—unlike these two we just talked about—a procedure done in the operating room. It's very TURP like in its effect except that it's not performed by a heated wire loop; it's performed with cool water and a jet of this water that's marching through the prostate. We would begin the procedure by kind of defining the parameters of where we want this water to go and in the course of this, little pieces of prostate are being released—takes about 3-5 minutes to ablate, to excavate a prostatic cavity, right, to open up that channel and then there may be some bleeding, sort of go in and do some cautery, and there's a catheter, but in the end probably a safer TURP. 

And that's interesting to me, the technology is fascinating. There could be some impediments, one, of course, is the anesthesia and the catheter. The other is, it's not inexpensive to get one of these units into your operating room, and you know, TURPS can be done for, you know, the $80 of a little wire loop. So I'm not sure how that process is gonna go forward, but it has been approved and is starting to make waves. 

Dr. Moyad: So it is FDA approved? 

Dr. Gange: Yes.

Dr. Moyad: It is an option?

Dr. Gange: FDA cleared, right.

Dr. Moyad: Aquablation, it's basically done in the OR's in the hospital?

Dr. Gange: Right.

Dr. Moyad: So, okay, so that's the latest thing that people can check on. 

Dr. Gange: Yeah, it's interesting. I think when we start talking about prostate cancer patients, you know, PCRI, relevance, certainly would be something I'd be uncomfortable with post-radiation. I may be slightly more comfortable than with TURP because there's no heat, it's sort of controlled temperature. It's still working through an altered environment. I'd be more concerned about these little jets of water going somewhere they shouldn't go. 

Dr. Moyad: Yeah.

Dr. Gange: And there's no data at all yet on this. Certainly before therapy of any sort, I suppose it would make sense to consider this. 

Dr. Moyad: Yeah, but all the ones you talked about—we talked about UroLift, Rezum, Aquablation—all these are moving into the realm of looking at men, eventually, who have been treated for prostate cancer to see if you can make the situation better. 

Dr. Gange: I think that there is some crossover. I don't think it's going to apply to everything. Absolutely, but at least it provides something else besides throwing out a pill, the pill doesn't work, then what? And not to mention, you know, all these guys on active surveillance, that's probably the bulk of patients with prostate cancer diagnoses, they need something for their BPH. They have both conditions, you know. And it's not the cancer causing their nighttime urination or their flow issues, so the more they know about these options the more proactive they can be about intervening and improving their quality of life. 

Dr. Moyad: Absolutely. The more you control—what I call—that background noise that complicates the PSA situation, right? 

Alright, man that's a lot of stuff.