by Dr Neal Patel M.D.

Director of Minimally Invasive Surgery

What Is Pulsed Electric Field Ablation (PEFA) and Who Is It For?

Prostate cancer is the most common cancer in men after skin cancer, and it’s one that comes with many options for treatment. Historically, patients had to choose between watchful waiting or active surveillance, radiation therapy, or surgery such as a radical prostatectomy. Each of these paths has strong merits, but also trade-offs—especially when it comes to quality of life issues like urinary continence and sexual function.

Today, however, a newer, less invasive option called Pulsed Electric Field Ablation (PEFA) is emerging as a game-changer for many men with localized prostate cancer. By using precisely controlled electrical pulses to selectively destroy cancerous tissue while sparing critical structures, PEFA offers the possibility of excellent cancer control with significantly fewer side effects than traditional treatments.

This article takes a deep dive into what PEFA is, how it works, its benefits, risks, and—most importantly—who is the right candidate for it. At the end, we include a patient-friendly FAQ to answer the most common questions.

Understanding PEFA: A New Frontier in Prostate Cancer Care

What Does “Pulsed Electric Field Ablation” Mean?

PEFA is a non-thermal focal therapy. That means it doesn’t rely on extreme heat (like high-intensity focused ultrasound, or HIFU) or extreme cold (like cryotherapy) to kill prostate cancer cells. Instead, PEFA uses short, high-voltage electrical pulses delivered between electrode probes that have been carefully placed into the prostate under image guidance.

These pulses create a phenomenon called irreversible electroporation (IRE). At the cellular level, the electrical fields punch permanent nanopores into the cell membranes. Cancer cells can’t recover from this membrane disruption, leading to cell death. Importantly, because PEFA is non-thermal, it spares nearby connective tissue, blood vessels, and nerves—structures that are critically important for continence and sexual function.

Why Is This Different From Other Focal Therapies?

Other focal therapies like HIFU or cryotherapy can damage surrounding tissues because of heat spread or freeze injury. PEFA’s electrical energy is confined to the targeted field, giving it precise boundaries and reducing collateral injury. That’s why many experts consider it among the most promising approaches for preserving quality of life.

How PEFA Is Performed

Planning the Procedure

• MRI imaging is essential. It helps map the exact location, size, and extent of the prostate tumor.
• In some cases, MRI-ultrasound fusion is used during biopsy and treatment to precisely target the cancerous lesion.

The Procedure Itself

• PEFA is typically performed in an outpatient or short-stay setting under general anesthesia.
• Thin electrode probes are placed into the prostate under ultrasound guidance, guided by MRI mapping.
• Controlled electrical pulses are delivered between the probes.
• Treatment usually takes less than an hour.

Recovery

• Most patients go home the same day or the next morning.
• A catheter is often left in place temporarily (usually 3–5 days).
• Patients typically return to normal activities within a few days to a week.

The Benefits of PEFA

1. Organ-Sparing Approach

Unlike radical prostatectomy or whole-gland radiation, PEFA does not remove or destroy the entire prostate. It focuses only on the cancerous region. This means:

• Preservation of healthy tissue
• Lower risk of urinary incontinence
• Better likelihood of maintaining erectile function

2. Non-Thermal Safety

Because no heat or freezing is involved:

• Delicate nerves around the prostate are less likely to be injured
• Risk of urethral or rectal damage is lower
• Healing is generally quicker

3. Outpatient Convenience

• Minimally invasive, often same-day discharge
• Short recovery time
• Less disruption to work and family life

4. Preserving Future Options

Perhaps one of the most important advantages:

If PEFA does not completely eradicate the cancer—or if new disease develops later—patients can still undergo surgery or radiation. This is not always the case with some other focal or experimental therapies that can complicate future treatment.

5. Excellent Quality of Life Outcomes

Early studies and clinical experience show:

• Very low rates of urinary leakage
• Strong preservation of erectile function compared to surgery or radiation
• Minimal bowel side effects

Risks and Limitations of PEFA

Like any medical treatment, PEFA has potential downsides:

• Urinary symptoms such as frequency, urgency, or mild burning may occur for a few weeks
• Temporary urinary retention requiring catheter support can happen but is usually transient
• Erectile dysfunction is possible, especially if the tumor is near the nerve bundles, though the risk is much lower than with whole-gland treatments
• Cancer recurrence is possible, since only part of the gland is treated. This makes close follow-up with PSA testing and MRI essential.

PEFA is not currently recommended for men with very large prostates, extensive multifocal disease, or high-risk cancers that extend beyond the gland. For those patients, surgery or radiation often remain the best option.

Who Is PEFA For?

The ideal candidates are men with:

• Localized prostate cancer (confined to the gland)
• Low-risk or favorable intermediate-risk disease
  
  • Gleason 6 (Grade Group 1)
  • Gleason 7 (Grade Group 2, 3+4)
• MRI-visible lesion that is accessible for probe placement
• PSA and volume parameters consistent with a focal strategy
• Men who want treatment but also want to preserve urinary and sexual function
• Patients who value keeping other options open for the future

Gleason 6 (Low-Risk)

For many men with Gleason 6 prostate cancer, active surveillance is a very reasonable option. However, some men prefer active treatment rather than continued monitoring. For these men, PEFA offers an excellent balance: effective local treatment with minimal disruption to quality of life.

Gleason 7 (Intermediate-Risk)

Among Gleason 7 cancers, those with a 3+4 pattern (favorable intermediate risk) are particularly well-suited to PEFA. Select cases of 4+3 (unfavorable intermediate) may also be considered if the disease is still relatively localized and accessible.

Who It’s Not For

• Men with high-risk or very aggressive cancers (Gleason 8–10, large volume, or extracapsular spread)
• Patients with multifocal disease scattered throughout the gland
• Men unable to undergo MRI imaging or anesthesia

For these patients, robotic prostatectomy or radiation therapy may be more appropriate.

Comparing PEFA to Other Options

Treatment	Best For	Strengths	Tradeoffs
Active Surveillance	Gleason 6, low-volume 3+4	Avoids treatment side effects	Requires long-term monitoring, some anxiety
PEFA	Gleason 6 and select Gleason 7, MRI-visible lesions	Organ-sparing, fast recovery, preserves future options	Requires precise selection, close follow-up, not ideal for high-risk
Robotic Prostatectomy (RALP)	High-grade or high-volume disease	Definitive removal, full pathology	Higher risk of incontinence/ED, longer recovery
Radiation Therapy	Intermediate/high-risk, men not surgical candidates	Non-surgical, effective across risk groups	Gradual erectile changes, bowel/urinary side effects
Other focal therapies (HIFU, Cryo)	Select focal disease	Organ-sparing, outpatient	Higher risk of thermal injury, less precise than PEFA

What Does the Evidence Say?

Clinical data on PEFA (often published under the broader category of irreversible electroporation) is growing. Published series report:

• High rates of local control in carefully selected patients
• Excellent functional outcomes—continence typically preserved, potency preserved in a majority of patients
• Repeatability—PEFA can be performed again if needed
• Feasibility of salvage—men can still undergo surgery or radiation later with good outcomes

While long-term data is still being collected, the early results are highly encouraging, and patient demand is increasing as awareness spreads.

Life After PEFA: What Patients Can Expect

1. Short-Term Recovery
   
   • Catheter for several days
   • Temporary urinary urgency/frequency
   • Resume normal activity quickly
3. Follow-Up Protocol
   
   • PSA checks every 3–6 months
   • MRI at defined intervals to monitor treated zone
   • Repeat biopsy in some cases to confirm control
5. Quality of Life
   
   • Majority remain continent
   • Sexual function generally well preserved, especially when treatment is away from neurovascular bundles
   • Minimal impact on bowel function

Patient FAQ: Pulsed Electric Field Ablation (PEFA)

How long will I have a catheter after PEFA?

Most men will need a catheter for about 3–5 days after the procedure, depending on anatomy and extent of treatment.

Will I be able to go back to work quickly?

Yes. Most patients return to desk work in a few days, and to light physical activity within a week.

Can I still have surgery or radiation later if needed?

Absolutely. One of the biggest advantages of PEFA is that it preserves all future options. If cancer recurs or progresses, surgery and radiation remain viable.

Does PEFA affect my sexual function?

Most men maintain erections after PEFA, particularly when the lesion is not right next to the nerve bundles. Compared with surgery and radiation, PEFA generally has better functional outcomes.

How will I be monitored after PEFA?

Follow-up includes PSA blood tests, MRI scans, and sometimes a repeat biopsy to confirm cancer control. Surveillance is key because only part of the gland is treated.

Is PEFA painful?

The procedure is performed under anesthesia, so you won’t feel pain during treatment. Some men experience mild pelvic soreness or urinary irritation for a few days afterwards, but it is usually manageable with over-the-counter medications.

Is insurance covering PEFA?

Coverage is expanding as evidence grows. Our team at Atlanta Prostate Center works directly with patients and insurers to clarify coverage and out-of-pocket expectations before treatment.

The Role of Atlanta Prostate Center in Offering PEFA

One of the key challenges men face when diagnosed with prostate cancer is that many centers or practices only offer one or two treatments. Surgeons often emphasize surgery. Radiation centers emphasize radiation. Patients can feel pressured into a treatment pathway that may not truly match their disease profile or life goals.

At Atlanta Prostate Center, we believe the best care is comprehensive and patient-centered. That means offering:

• Active surveillance with cutting-edge MRI protocols
• PEFA, the most advanced focal therapy option
• Robotic prostatectomy (RALP) for higher-risk or higher-volume cancers
• Radiation therapy for those who are medically fragile or prefer non-surgical care

By having all options under one roof, our team can guide patients to the treatment that best fits their cancer, their health, and their personal priorities.

Key Takeaways

• PEFA (Pulsed Electric Field Ablation) is a non-thermal, minimally invasive focal therapy for prostate cancer.
• It works by using electrical pulses to selectively destroy cancer cells while sparing surrounding structures.
• Best suited for men with Gleason 6 and favorable Gleason 7 (3+4) disease that is localized and visible on MRI.
• Benefits include organ preservation, rapid recovery, excellent quality-of-life outcomes, and preservation of future treatment options.
• It is not appropriate for men with high-grade, high-volume, or extensively multifocal cancers.
• Atlanta Prostate Center is uniquely positioned to offer PEFA alongside all other major therapies, ensuring each patient gets truly individualized care.