A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
November 7th, 2025
Overtreatment is often administered to patients with low-risk prostate cancer; super-active surveillance can help avoid such overtreatment.
I focus on prostate cancer, where many patients with low-risk disease still undergo unnecessary treatment. My goal is to develop a more proactive and patient-centered approach to active surveillance. Currently our imaging technologies are needed to identify latency, enable prices, focal tumor eradication, and achieve the optimal balance between oncological control and functional preservation.
Super active surveillance is a safe, effective, and feasible novel treatment street for low-risk prostate cancer. Cryoablation for prostate cancer demonstrates the great potential of the application of cryotherapy and immunotherapy, and the immune effect of cryoablation require more clinical and basics research to explore the specific mechanism. To begin, obtain a patient list that includes patients who have a pathologically-confirmed diagnosis of prostate adenocarcinoma obtained through a prostate system puncture.
Ensure the availability of a cryotherapy system and a real-time image fusion ultrasound system. Prepare a USB flash drive containing 18F-PSMA PET/MR imaging data. Next, choose the appropriate puncture target framework according to the prostate volume and tumor location.
Prepare a V-shaped variable cryoprobe with an adjustable diameter range from 1.5 to five centimeters and two temperature probes. Now, connect the USB flash drive to the integrated ultrasound system. Import the imaging data into the ultrasound fusion software for preoperative planning and target marking.
Complete the full cryoablation preoperative plan. Next, position the patient in the lithotomy position. Administer 0.5 grams of levofloxacin intravenously 30 minutes before surgery.
Insert a three-lumen pure silicone catheter following the infusion. Apply ultrasound and preoperative planning markers from the 18F-PSMA PET/MR images to perform intraoperative registration. Now, insert the variable probe into the identified lesion using the image fusion guidance.
Place a temperature probe in the perineal puncture site anterior to the rectum or in the Denonvilliers fascia. Irrigate the bladder with saline solution through the three-lumen catheter to protect the urethra from frostbite. To start the cryotherapy system, rapidly lower the front end of the cryoprobe to below minus 140 degrees Celsius.
Use ultrasound to monitor the ice ball formation in real time, ensuring its edge extends 0.5 centimeters beyond the preoperative tumor boundary while keeping the rectal temperature probe above zero degrees Celsius. Gradually reduce the freezing power while maintaining the ice ball's coverage area for five minutes. Apply helium gas to rapidly warm the probe tip to above 15 degrees Celsius, and maintain the temperature for five minutes.
Once cryotherapy is complete, remove all probes from the patient. Apply pressure to the puncture site to stop bleeding and cover with a sterile dressing. Observe the urine color in the catheter.
If the urine is clear, do not perform bladder irrigation. If blood is visible, perform bladder irrigation, then transfer the patient to the anesthesia recovery room. Nine patients underwent surgery successfully without any intraoperative complications.
A total of 12 prostate adenocarcinoma lesions were treated using cryoablation across the nine patients. The median postoperative follow-up time was 37 months, with a range of 14 to 61 months.
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Overview
This article discusses the issue of overtreatment in patients with low-risk prostate cancer and introduces the concept of super-active surveillance as a potential solution. The approach aims to balance oncological control with functional preservation.
Key Study Components
Area of Science
- Oncology
- Prostate Cancer
- Active Surveillance
Background
- Many patients with low-risk prostate cancer receive unnecessary treatments.
- Current imaging technologies are essential for monitoring disease progression.
- There is a need for a patient-centered approach to treatment.
- Cryoablation and immunotherapy show promise in prostate cancer management.
Purpose of Study
- To develop a proactive approach to active surveillance for low-risk prostate cancer.
- To explore the potential of cryoablation and its immune effects.
- To identify patients suitable for super-active surveillance.
Methods Used
- Patient list compilation with pathologically-confirmed prostate adenocarcinoma.
- Utilization of advanced imaging technologies.
- Assessment of treatment outcomes and patient safety.
- Investigation of cryotherapy and immunotherapy mechanisms.
Main Results
- Super-active surveillance is shown to be safe and effective.
- Cryoablation demonstrates significant potential in treatment.
- Further research is needed to understand the immune effects of cryoablation.
- Optimal balance between treatment efficacy and patient quality of life is achievable.
Conclusions
- Super-active surveillance can reduce overtreatment in low-risk prostate cancer.
- Innovative imaging and treatment methods are crucial for patient management.
- Continued research is essential for improving treatment strategies.
Frequently Asked Questions
Executive Industry Relevance
Super Active Surveillance (Super-AS) addresses overtreatment in low-risk prostate cancer by integrating advanced imaging and focal cryoablation to balance oncological control with functional preservation. This approach enables precise, minimally invasive intervention, supporting risk-adjusted decision-making at the interface of active surveillance and definitive therapy. Super-AS offers a strategic bridge for portfolio managers seeking to optimize patient outcomes while minimizing unnecessary interventions.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables interrogation of focal tumor biology using multimodal imaging and targeted ablation.
- Supports functional validation of imaging biomarkers for disease localization and monitoring.
- Facilitates mechanistic de-risking by correlating imaging, ablation, and clinical outcomes.
Screening & Assay Development
- Establishes reproducible imaging and ablation protocols for consistent patient selection.
- Standardizes quantitative imaging outputs for downstream clinical and translational studies.
- Prepares validated patient cohorts for evaluating novel focal therapies or imaging agents.
Translational & Preclinical Research
- Aligns imaging and focal therapy endpoints with disease-relevant clinical outcomes.
- Enables translational biomarker development by linking imaging findings to therapeutic response.
- Supports risk-adjusted advancement of focal therapy strategies in early-stage disease.
Pipeline & Workflow Integration
Super-AS integrates advanced imaging, real-time ultrasound fusion, and focal cryoablation within the localized prostate cancer management continuum, bridging active surveillance and radical intervention.
- Discovery Biology: Provides a platform for hypothesis testing of focal therapy efficacy and imaging biomarker performance.
- Screening: Delivers standardized imaging and procedural criteria for patient stratification and trial readiness.
- Analytics: Generates quantitative imaging and procedural data to inform comparative analyses and outcome prediction.
- Translational Research: Connects imaging-guided interventions to functional and oncological endpoints relevant for preclinical and clinical translation.
- Enterprise Reuse: Establishes a modular workflow adaptable to evolving imaging modalities and focal therapy technologies.
Operational & Enterprise Impact
- Scientific Value: Enhances predictive confidence in focal therapy outcomes and imaging biomarker utility.
- Operational Value: Promotes standardization, reproducibility, and scalability of imaging-guided ablation protocols.
- Strategic Value: Informs go/no-go decisions for focal therapy adoption and imaging platform investment.
- Portfolio Impact: Supports risk-adjusted prioritization of minimally invasive interventions in early-stage prostate cancer.
Implementation Considerations
- Requires expertise in multimodal imaging interpretation and image-guided intervention.
- Demands access to integrated PET/MR, ultrasound fusion, and cryoablation systems.
- Necessitates cross-team standardization of imaging, procedural, and follow-up protocols.
- Adaptation may be needed for different prostate volumes and tumor locations.
- Long-term outcome data and immune response mechanisms require further investigation.
