Focal therapy is not for every man with prostate cancer – but it is being used more often for certain patients with very limited, lower-risk cancer that is confined to the prostate.

The benefits of treating cancer within the prostate itself, rather than removing the entire gland surgically or destroying it with radiation, include fewer side effects: particularly, much lower risks of urinary incontinence or erectile dysfunction. Conversely, the risk is that focal therapy might not kill all the cancer – which is why, says Arvin George, M.D., Director of the Prostate Cancer Program at the Brady, rigorous follow-up is essential for patients who choose this option.

George performs laparoscopic and robotic radical prostatectomy on many patients, and he also performs focal therapy – which is still being studied – on a carefully selected cohort. He is heading several national clinical studies of various types of focal therapy, including cryotherapy, high-intensity focused ultrasound, nanoparticle-directed laser ablation, laser interstitial thermal therapy, and bipolar radiofrequency ablation. In a new study, he is investigating a novel tool: water vapor.

The study, “Vanquish® Water Vapor Ablation for PrOstateCancerR” (VAPOR2; NCT05683691), uses transurethral (through the urethra) water vapor – steam – to kill prostate cancer. “This trial is to examine the effectiveness of vapor ablation to prevent progression of disease risk,” says George.

Specifically, investigators are looking for effectiveness – to see if, three years after treatment, patients remain free from cancer; from cancer that is Gleason Grade Group level 2 or greater; and without need for salvage therapy.

“The primary safety endpoint is defined as freedom from incontinence at 12 months.” Men eligible for this study are age 50 or older with a prostate volume of 20-80 cc; a PSA of 15 or lower; cancer stage T2c or lower, with Grade Group 2 disease as confirmed by MRI fusion biopsy. Participants will undergo follow-up MRI and biopsy at six, 24, and 36 months, and will be followed for five years. The study is currently enrolling patients. For more information, please visit: https://clinicaltrials.gov/study/NCT05683691.