Prostate Cancer Treatment | Dr. Xue Wei (Urology) | CMCS Shanghai

About Prof. Xue Wei

Prof. Xue Wei is a leading urologist and urological oncologist at Renji Hospital, Shanghai Jiao Tong University School of Medicine — one of China's foremost centres for urological oncology, robotic-assisted urological surgery, and minimally invasive treatment of prostate, bladder, and kidney cancers. He is recognised as a pioneer in minimally invasive urologic oncology in China, with extensive experience in robotic-assisted radical prostatectomy, laparoscopic urological surgery, and the development and clinical application of novel ablative technologies for urological malignancies. Prof. Xue's clinical philosophy holds that the treatment of prostate cancer — particularly in elderly patients with significant comorbidities and functional preservation priorities — must be individualised to the patient's tumour characteristics, functional status, and personal treatment goals, and that the expanding toolkit of focal and ablative therapies offers meaningful alternatives to radical surgery and radiotherapy for carefully selected patients who wish to preserve urinary continence and sexual function. His department at Renji Hospital has been designated as the national multicentre clinical research lead institution for nanosecond pulse tumour ablation in prostate cancer — a role that reflects the department's commitment to advancing the evidence base for next-generation ablative technologies and making them available to Chinese patients who stand to benefit most from their precision and functional preservation advantages.

Case Overview

Mr. Zhang (pseudonym), a 79-year-old Chinese man, presented with a four-year history of progressive urinary difficulty with significant worsening over the preceding six months. Prostate MRI and biopsy confirmed the diagnosis of prostate cancer. Given his advanced age, reduced physiological reserve, and the significant risks of urinary incontinence and other functional sequelae associated with radical surgery, the radiation-related side effects of radiotherapy, and the systemic adverse effects of hormonal therapy, Prof. Xue Wei's team conducted a comprehensive assessment and determined that nanosecond pulse tumour ablation — a next-generation pulsed electric field technology capable of precise focal destruction of cancer cells while protecting surrounding healthy tissue and neurovascular structures — was the optimal treatment strategy. A precision focal ablation plan was formulated using the nanosecond pulse ablation system with single-use electroporation electrodes, performed under image guidance with precise electrode placement at the tumour margins. The procedure was completed without surgical incision. The urinary catheter was removed on postoperative day one, and the patient was discharged in good condition. This case represents the first clinical application of nanosecond pulse tumour ablation for prostate cancer in China — a landmark achievement that establishes a new standard for functional-preservation focal therapy in elderly and high-surgical-risk prostate cancer patients.

Patient Background

• Name / Nationality: Mr. Zhang (pseudonym) — Chinese male, 79 years old
• Age / Sex: 79-year-old male
• Chief Complaint: Progressive urinary difficulty for four years, significantly worsened over the preceding six months; urinary hesitancy, weak stream, and incomplete bladder emptying
• History of present illness: Four-year history of progressive lower urinary tract symptoms consistent with bladder outlet obstruction; symptoms significantly worsened over the six months prior to presentation — urinary hesitancy, markedly reduced urinary stream, sensation of incomplete bladder emptying, and nocturia. Prostate MRI demonstrated a suspicious lesion; targeted biopsy confirmed prostate cancer. The patient was referred to Prof. Xue Wei's team for specialist urological oncology assessment and treatment planning.
• Treatment considerations:
  • Radical surgery: Advanced age and reduced physiological reserve; significant risk of urinary incontinence and erectile dysfunction; prolonged recovery — assessed as high-risk and disproportionate to the patient's functional status and life expectancy
  • Radiotherapy: Risk of radiation cystitis and proctitis — urinary frequency, dysuria, diarrhoea, and abdominal pain; prolonged treatment course; not preferred given the patient's age and symptom burden
  • Hormonal therapy: Systemic adverse effects — fatigue, muscle loss, cognitive decline, cardiovascular risk; not preferred as primary local treatment given the localised nature of the disease
  • Nanosecond pulse ablation: Precision focal therapy; no surgical incision; preservation of surrounding neurovascular structures; rapid recovery; activation of immune response — assessed as the optimal treatment strategy for this patient

Diagnostic Workup

Imaging

• Multiparametric MRI of the prostate (mpMRI): Suspicious lesion identified — PI-RADS score assessed; tumour location, size, and relationship to the prostate capsule, neurovascular bundles, and urethra characterised; extracapsular extension and seminal vesicle invasion assessed
• Bone scan and CT: Distant metastasis excluded; disease confirmed as localised to the prostate

Biopsy and Pathology

• MRI-targeted prostate biopsy: Histopathological confirmation of prostate adenocarcinoma; Gleason score and Grade Group assessed; tumour extent and distribution within the biopsy cores documented
• PSA: Serum PSA level measured and documented as part of risk stratification

Functional Assessment

• Urinary function: International Prostate Symptom Score (IPSS) assessed; uroflowmetry and post-void residual volume measured; baseline urinary continence status documented
• Sexual function: baseline erectile function assessed using validated questionnaire
• Physiological reserve: comprehensive geriatric assessment performed; anaesthetic risk stratified; fitness for the planned procedure confirmed

Prof. Xue's pre-procedural assessment: This patient presents us with the clinical challenge that is increasingly common in urological oncology — a man in his late seventies with localised prostate cancer, significant lower urinary tract symptoms, and a physiological profile that makes radical surgery high-risk and radiotherapy burdensome. The standard treatment options each carry a side effect profile that is disproportionate to the benefit in a patient of this age and functional status. Nanosecond pulse ablation offers something that none of the standard options can provide: precise focal destruction of the tumour with preservation of the surrounding neurovascular structures, no surgical incision, and a recovery measured in days rather than weeks or months. The mechanism is fundamentally different from thermal ablation — the nanosecond pulse electric field acts directly on the cell membrane and nucleus, inducing apoptosis through a non-thermal mechanism that spares the extracellular matrix and the vascular structures within the ablation zone. This means we can ablate the tumour without the collateral thermal damage to the urethra, the sphincter, and the neurovascular bundles that limits the functional outcomes of other ablative technologies. For this patient, nanosecond pulse ablation is not a compromise — it is the right treatment.

Treatment Strategy: Precision Focal Nanosecond Pulse Ablation

The diagnosis was Localised Prostate Cancer in a 79-year-old patient with high surgical risk and functional preservation priorities.

The treatment principle was: precision focal ablation of the prostate tumour using nanosecond pulse electroporation technology — achieving targeted cancer cell destruction through non-thermal pulsed electric field mechanisms, with preservation of surrounding neurovascular structures, urinary sphincter, and rectal wall, and activation of the host immune response to clear apoptotic tumour cells.

Procedure — Nanosecond Pulse Tumour Ablation (Nanosecond Pulsed Electric Field Ablation):

• Mechanism of action: The nanosecond pulse ablation system delivers ultra-short high-voltage electrical pulses (nanosecond duration, tens of thousands of volts) to the target tissue. The ultra-short pulse duration allows the electric field to penetrate the cell membrane and act directly on intracellular structures — including the nucleus — inducing irreversible disruption of the intracellular and extracellular environment and triggering rapid cancer cell apoptosis and necrosis through a non-thermal mechanism. The electric field selectively targets cells based on their electrical properties, sparing the extracellular matrix, blood vessels, and connective tissue structures within the ablation zone. The destruction of cancer cells by apoptosis releases tumour-associated antigens that activate the host immune system — stimulating phagocytosis and clearance of apoptotic cells and potentially generating a systemic anti-tumour immune response
• Image-guided electrode placement: Procedure performed under real-time ultrasound and/or MRI guidance; single-use electroporation electrodes advanced transperineally into the prostate under image guidance; electrode tips positioned precisely at the margins of the tumour target volume as defined by the preoperative mpMRI and biopsy mapping; electrode position confirmed by imaging before ablation delivery
• Ablation delivery: Nanosecond pulse sequences delivered through the positioned electrodes; ablation parameters — pulse duration, voltage, number of pulses, and inter-electrode configuration — optimised for the tumour volume and location; real-time monitoring of ablation delivery and tissue response
• Procedure completion: No surgical incision; procedure performed under general or spinal anaesthesia; urinary catheter placed at the time of the procedure; patient transferred to recovery

Treatment Course and Outcomes

Procedural

• Nanosecond pulse tumour ablation completed successfully under Prof. Xue Wei's guidance; image-guided electrode placement confirmed accurate targeting of the tumour; ablation delivered per protocol; no intraoperative complications; no surgical incision

Postoperative Day One

• Urinary catheter removed successfully on postoperative day one — the patient voided spontaneously without difficulty; no urinary retention; no haematuria requiring intervention
• No pain requiring parenteral analgesia; patient ambulatory and comfortable

Discharge and Early Recovery

• Patient discharged in good condition; recovery rapid and uncomplicated; no wound care required (no surgical incision); no urinary incontinence; urinary symptoms improved compared with pre-procedural baseline
• Patient and family highly satisfied with the procedure and recovery experience

Prof. Xue's clinical reflection: The catheter came out on day one and the patient went home — that is the recovery profile that nanosecond pulse ablation offers, and it is a recovery profile that radical surgery and radiotherapy cannot match in a 79-year-old man. The non-thermal mechanism is what makes this possible: because we are not producing a zone of thermal necrosis that extends beyond the tumour target, the urethra and the sphincter are not damaged by the ablation, and the patient retains his urinary control from the first day after the procedure. The immune activation is an additional benefit that we are still characterising in the clinical research programme — the release of tumour antigens from the apoptotic cancer cells may generate a systemic immune response that contributes to long-term tumour control beyond the ablation zone. This is the first case of nanosecond pulse ablation for prostate cancer in China, and Renji Hospital is the national lead institution for the multicentre clinical research programme that will define the evidence base for this technology. The results of this first case are exactly what the technology promised — precise focal ablation, preserved function, rapid recovery. We look forward to building the evidence that will make this treatment available to the many patients who stand to benefit from it.

Expert Commentary — Prof. Xue Wei

1. Nanosecond Pulse Ablation: Mechanism, Advantages Over Conventional Ablative Technologies, and the Biological Basis for Functional Preservation

Nanosecond pulse tumour ablation — also termed nanosecond pulsed electric field (nsPEF) ablation — represents a fundamentally new category of ablative technology that differs from all existing thermal and non-thermal ablative modalities in its mechanism of action and its biological effects on target tissue. Conventional thermal ablative technologies — radiofrequency ablation, microwave ablation, high-intensity focused ultrasound (HIFU), and cryoablation — destroy tumour cells by producing extreme temperatures within the ablation zone; the thermal injury is non-selective, affecting all tissue components within the zone including the extracellular matrix, blood vessels, nerves, and connective tissue structures. This non-selectivity is the fundamental limitation of thermal ablation in the prostate: the proximity of the urethra, the urinary sphincter, the neurovascular bundles, and the rectal wall to the tumour target means that thermal ablation of the tumour inevitably risks thermal injury to these critical structures, with consequent urinary incontinence, erectile dysfunction, and rectal injury. Nanosecond pulse ablation operates through a non-thermal mechanism: the ultra-short high-voltage pulses — with durations measured in nanoseconds and voltages of tens of thousands of volts — generate an electric field that penetrates the cell membrane and acts directly on intracellular structures, inducing irreversible disruption of the intracellular environment and triggering apoptosis through a mechanism that is independent of temperature elevation. Because the mechanism is non-thermal, the extracellular matrix, blood vessels, and connective tissue structures within the ablation zone are spared — they lack the intracellular targets that the nanosecond pulse field acts upon. This selective cellular destruction with preservation of the extracellular scaffold is the biological basis for the functional preservation advantages of nanosecond pulse ablation: the urethra, sphincter, and neurovascular bundles can be preserved even when the ablation zone extends to their margins, because the non-thermal mechanism does not produce the collateral structural damage that limits the functional outcomes of thermal ablation.

2. Focal Therapy for Prostate Cancer: Patient Selection, Oncological Principles, and the Role of Nanosecond Pulse Ablation

Focal therapy for prostate cancer — the targeted ablation of the index lesion or the dominant tumour focus within the prostate, rather than treatment of the entire gland — has emerged as a clinically meaningful treatment option for carefully selected patients with localised, low-to-intermediate risk prostate cancer who wish to preserve urinary continence and sexual function. The oncological rationale for focal therapy rests on the evidence that the index lesion — the dominant, highest-grade tumour focus — is the primary driver of metastatic progression in prostate cancer, and that targeted ablation of the index lesion may provide durable local control with a side effect profile substantially better than whole-gland treatment. Patient selection for focal therapy requires careful assessment of tumour characteristics — tumour location, volume, grade, and extent as defined by multiparametric MRI and targeted biopsy mapping — to identify patients whose disease is sufficiently localised and well-characterised to be amenable to focal ablation with acceptable oncological risk. The ideal focal therapy candidate has a unifocal or dominant index lesion that is clearly defined on mpMRI, is located away from the urethra and neurovascular bundles, and has a Gleason grade and PSA profile consistent with intermediate-risk disease. In elderly patients with significant comorbidities — such as Mr. Zhang, aged 79 with reduced physiological reserve — the threshold for focal therapy is appropriately lower, because the competing risks of radical treatment are higher and the life expectancy within which the oncological benefit of radical treatment would be realised is shorter. Nanosecond pulse ablation is particularly well-suited to focal therapy in this patient population because its non-thermal mechanism allows ablation of tumour foci in close proximity to the urethra and neurovascular bundles without the functional risks that limit the application of thermal focal therapy technologies in these anatomically challenging locations.

3. China's National Multicentre Clinical Research Programme in Nanosecond Pulse Ablation: Building the Evidence Base for a New Standard of Care

The designation of Renji Hospital as the national lead institution for the multicentre clinical research programme in nanosecond pulse ablation for prostate cancer reflects both the department's clinical expertise in urological oncology and its commitment to generating the rigorous clinical evidence that is required to establish a new ablative technology as a standard of care. The clinical research programme is designed to answer the key questions that remain to be addressed for nanosecond pulse ablation in prostate cancer: the oncological efficacy of focal ablation — PSA response, biopsy-confirmed local control, and metastasis-free survival at defined follow-up intervals; the functional outcomes — urinary continence, erectile function, and quality of life compared with radical surgery, radiotherapy, and other focal therapy modalities; the safety profile — procedure-related complications, device-related adverse events, and the learning curve for safe and effective electrode placement; and the optimal patient selection criteria — the tumour characteristics, patient profile, and functional priorities that predict the best oncological and functional outcomes with nanosecond pulse ablation. The multicentre design — enrolling patients across multiple institutions with standardised protocols, centralised data collection, and independent outcome adjudication — will generate the level of evidence required for regulatory approval, guideline inclusion, and broad clinical adoption of nanosecond pulse ablation as a treatment option for Chinese prostate cancer patients. The first case performed at Renji Hospital — documented in this report — is the clinical and scientific foundation of that programme: the proof of concept that nanosecond pulse ablation can be safely and effectively performed in a Chinese patient with localised prostate cancer, with the functional preservation and rapid recovery outcomes that the technology's mechanism of action predicts.

How CMCS Shanghai Coordinated This Case

CMCS Shanghai supported Mr. Zhang and his family throughout the diagnostic, treatment planning, procedural, and recovery pathway at Renji Hospital, Shanghai Jiao Tong University, including: priority consultation coordination with Prof. Xue Wei's urology team, with bilingual review of all prior prostate MRI, biopsy pathology, PSA results, and clinical records; bilingual interpretation throughout the treatment planning consultation, procedural consent discussion, and all postoperative review appointments; bilingual explanation of the nanosecond pulse ablation technology — its mechanism of action, the advantages over radical surgery and radiotherapy for this patient's profile, the procedural steps, the expected recovery timeline, and the follow-up monitoring plan; coordination of preoperative mpMRI, bone scan, uroflowmetry, and functional assessments with bilingual results communication and clinical summary; bilingual procedural consent process — ensuring the patient and family had a complete understanding of the procedure, the expected functional outcomes, and the oncological follow-up requirements; postoperative recovery coordination including bilingual communication of catheter removal, discharge planning, and early recovery milestones; and long-term oncological follow-up coordination including PSA monitoring, repeat mpMRI scheduling, and bilingual communication of surveillance results.

For international patients with prostate cancer — including elderly or high-surgical-risk patients seeking functional-preservation focal therapy alternatives to radical surgery and radiotherapy — Prof. Xue Wei's team at Renji Hospital, Shanghai Jiao Tong University, offers access to China's most advanced urological oncology programme, including the national clinical research programme in nanosecond pulse ablation. CMCS ensures that expertise is accessible: in the patient's language, with every step of the diagnostic, treatment, and surveillance pathway coordinated and communicated clearly, from the first specialist consultation through long-term oncological follow-up.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.