Prostate Cancer Treatment: Radiation vs Pulsed Electrical Field Ablation (PEFA)

Introduction

Being diagnosed with prostate cancer is life-changing. Once you hear the words “you have prostate cancer,” your mind floods with questions: What are my options? Which treatment will work best for me? What side effects should I expect? Will my quality of life be preserved?

Traditionally, men with localized prostate cancer were presented with two main curative approaches: surgery (radical prostatectomy) or radiation therapy. Both are effective at eradicating cancer but carry significant risks, particularly urinary incontinence, bowel dysfunction, and erectile dysfunction.

Now, innovative approaches are emerging. One of the most exciting is Pulsed Electrical Field Ablation (PEFA) — a non-thermal focal therapy that selectively destroys cancer cells while sparing nearby nerves, blood vessels, and urinary structures.

This article provides a detailed comparison of radiation therapy versus PEFA, exploring their mechanisms, effectiveness, side effects, recovery, and suitability for different patients. Finally, we explain why PEFA is increasingly recognized as the best option for men with Gleason 6 and select Gleason 7 prostate cancers that are low-volume and confirmed by MRI.

Section 1: Understanding Prostate Cancer and Risk Stratification

Before diving into treatment comparisons, it’s important to understand how prostate cancer is classified and why treatment must be tailored.

Gleason Score / Grade Group:
Prostate cancer is graded based on microscopic appearance.
- Gleason 6 (Grade Group 1): Low-risk, usually slow-growing.
- Gleason 7 (3+4, Grade Group 2): Favorable intermediate risk.
- Gleason 7 (4+3, Grade Group 3): Higher risk within the intermediate category.
- Gleason 8–10 (Grade Groups 4–5): High risk, aggressive disease.
MRI Proven Lesion:
Modern multiparametric MRI (mpMRI) allows precise visualization of prostate cancer, enabling focal therapies to directly target the lesion.
Volume of Disease:
“Low-volume” means the cancer is limited to small, localized areas within the prostate rather than widespread throughout the gland.

For men with low-volume Gleason 6 and select Gleason 7 (3+4) cancers with clear MRI-proven lesions, focal therapy like PEFA offers a unique opportunity: treating the cancer while preserving quality of life.

Section 2: How Radiation Therapy Works

Radiation therapy has been a cornerstone of prostate cancer management for decades. It works by delivering high-energy beams (external beam radiation) or radioactive seeds (brachytherapy) to kill cancer cells by damaging their DNA.

Types of Radiation

External Beam Radiation Therapy (EBRT):
Daily sessions (typically 25–45 treatments over several weeks) where beams are directed at the prostate.
Brachytherapy:
Radioactive seeds implanted directly into the prostate for continuous low-dose radiation.
Combination Therapy:
Sometimes both EBRT and brachytherapy are combined for higher-risk cancers.

Effectiveness

Radiation provides excellent cancer control across low-, intermediate-, and high-risk groups. Long-term studies show:

10–15 year cancer-specific survival rates exceeding 90% for low- and intermediate-risk patients.
Effective even in patients who are not good surgical candidates.

Side Effects

However, radiation is not without drawbacks:

Urinary Symptoms: Frequency, urgency, and sometimes incontinence due to radiation cystitis.
Bowel Issues: Diarrhea, rectal bleeding, or irritation due to radiation proctitis.
Sexual Function: Erectile dysfunction rates increase over time, often appearing gradually years after treatment.
Second Cancers: Rare but possible, as radiation may slightly increase the risk of secondary malignancies.

Lifestyle Impact

Radiation treatment requires daily hospital visits for weeks, which may be burdensome for working men or those living far from treatment centers.

Section 3: How Pulsed Electrical Field Ablation (PEFA) Works

Pulsed Electrical Field Ablation (PEFA) is a new, non-thermal focal therapy. Instead of using heat (like HIFU or laser) or freezing (like cryotherapy), PEFA uses precisely delivered electrical pulses to create tiny nanopores in the membranes of cancer cells. This process disrupts cell function and leads to apoptosis (programmed cell death).

Key Features of PEFA

Non-Thermal: Surrounding nerves, sphincter, blood vessels, and connective tissue are preserved.
Focal Precision: Can target only the cancerous lesion, sparing healthy prostate tissue.
Immune Activation: Early research suggests PEFA may stimulate the immune system to recognize and attack cancer cells, offering a potential systemic benefit.
Outpatient Procedure: Typically performed under anesthesia in an ambulatory surgery center. Patients usually go home the same day.

Effectiveness

Early studies show high rates of local cancer control in low- and favorable-intermediate risk patients.
Repeat imaging and biopsies post-PEFA often confirm eradication of the targeted lesion.
PEFA can be repeated or followed by other treatments if needed, preserving future options.

Side Effects

Urinary Function: Most patients maintain excellent urinary control. Risk of incontinence is extremely low.
Sexual Function: Because nerves are spared, erectile function is often preserved far better than with radiation or surgery.
Recovery: Cramping, mild burning on urination, or temporary hematuria may occur but usually resolve quickly.

Lifestyle Impact

Most patients resume normal activities within a few days, compared to weeks with surgery or radiation.

Section 4: Head-to-Head Comparison – Radiation vs PEFA

Here’s a detailed comparison across key domains:

Factor	Radiation Therapy	Pulsed Electrical Field Ablation (PEFA)
Treatment Duration	Daily sessions for 5–9 weeks (EBRT) or single brachytherapy implant	Single outpatient procedure
Invasiveness	Non-surgical but requires multiple sessions	Minimally invasive, catheter/electrode-guided
Precision	Treats the whole prostate	Targets only MRI-proven lesion(s)
Side Effects	Urinary irritation, bowel symptoms, gradual ED	Minimal urinary/sexual side effects, nerves spared
Recovery Time	Weeks to months for side effects to stabilize	Days; return to work/activity quickly
Long-Term Data	Decades of survival outcomes available	Emerging but promising clinical data
Impact on Fertility	Ejaculation typically impaired post-radiation	Ejaculation volume reduced but fertility may be preserved if sperm banking is done
Future Treatment Options	Salvage surgery or ablation is more complex post-radiation	Future treatments remain possible; PEFA can be repeated
Ideal Candidate	All risk levels, especially higher-risk disease	Low-volume, MRI-visible Gleason 6 and 7 cancers

Section 5: Quality of Life Matters

For most men with prostate cancer, the biggest fear isn’t dying of the disease — it’s living with the side effects of treatment.

Radiation: Side effects often creep up slowly — erectile dysfunction, bowel leakage, or urinary frequency can worsen years later.
PEFA: By sparing key structures, PEFA minimizes risks to urinary and sexual function, allowing men to maintain quality of life.

Section 6: Which Patients Should Strongly Consider PEFA?

PEFA is not for every patient. It’s best suited for:

Men with Gleason 6 (low-risk) prostate cancer who want curative treatment rather than surveillance.
Men with Gleason 7 (3+4, favorable intermediate risk) cancers that are low-volume and clearly visible on MRI.
Patients who value preservation of sexual and urinary function.
Men who want outpatient, minimally invasive treatment with a quick recovery.
Patients who want to keep future treatment options open if needed.

Who Might Not Be Ideal

Patients with high-volume disease or Gleason 7 (4+3) or higher cancers.
Men with MRI-invisible cancers (not easily targeted).
Those with extensive prostate involvement who may benefit more from whole-gland therapy (radiation or surgery).

Section 7: The Role of MRI in Treatment Planning

One of the breakthroughs enabling PEFA is the widespread use of multiparametric MRI (mpMRI). MRI not only detects and characterizes prostate cancer lesions but also guides targeted treatment.

In PEFA, electrodes can be precisely placed to encompass the MRI-visible lesion and a margin of healthy tissue, maximizing cancer control while sparing normal anatomy.

This is why low-volume, MRI-proven lesions in Gleason 6 and 7 cancers are the ideal sweet spot for PEFA.

Section 8: Patient Experience – What to Expect with PEFA

Before Treatment: MRI and biopsy confirm eligibility.
Procedure Day: Outpatient, under anesthesia. Procedure lasts about 1–2 hours.
After Treatment: Brief recovery, go home same day.
First Week: Mild urinary symptoms possible. Pain managed with oral medication.
First Months: Blood/urine tests and MRI follow-up assess success.
Long Term: Symptom relief, low risk of incontinence or erectile dysfunction, preserved quality of life.

Section 9: Why Radiation Still Matters

Radiation remains an excellent, well-established option. It’s especially valuable for:

Men with higher-risk disease (Gleason 7 [4+3] or higher).
Patients not candidates for surgery due to other health issues.
Men with extensive or bilateral prostate involvement.

But for men with localized, low-volume disease, radiation may be overtreatment, exposing them to unnecessary side effects.

Section 10: The Future of Prostate Cancer Therapy

PEFA represents the new era of focal therapy — treating only what needs to be treated. As data grows, PEFA may shift from an emerging therapy to a new standard for low- and intermediate-risk patients.

In the future, it may also be combined with systemic treatments to harness its immune-activating effects.

Conclusion: Why PEFA is the Best Option for Select Patients

For men with Gleason 6 and favorable Gleason 7 prostate cancers that are low-volume and MRI-visible, Pulsed Electrical Field Ablation (PEFA) offers the best balance of cancer control and quality of life.

Unlike radiation, which exposes the entire prostate and surrounding tissues to energy (and the side effects that follow), PEFA targets only the cancer. It allows men to get back to normal life quickly, with a high likelihood of preserving sexual and urinary function.

Radiation remains an important tool, but for many men in Atlanta and across Georgia with early, localized disease, PEFA may be the smarter first choice.

Call to Action

If you or a loved one has been diagnosed with localized prostate cancer and want to explore all options — including advanced focal therapies like PEFA — reach out to a specialized prostate center. An expert team can help you determine if you’re a candidate and guide you toward the treatment that aligns with your goals.

👉 Schedule a consultation today to learn if PEFA is right for you.

Atlanta Prostate Center