Brian Mazzarella, MD, reviews early data on water vapor therapy for localized prostate cancer

In this video, Brian Mazzarella, MD, FACS, discusses the evolving management of localized intermediate-risk prostate cancer and early findings from the VAPOR 2 trial of water vapor ablation. Mazzarella is the vice president of clinical research at Urology Austin, an affiliate of Urology Alliance, in Austin, Texas.

For patients with localized intermediate-risk disease, treatment decisions include active surveillance, radiation therapy, and radical prostatectomy. Mazzarella explains that focal ablative approaches may offer an alternative for selected patients seeking treatment without whole-gland therapy. He notes that although first-line ablative therapy is not currently included as a guideline-recommended option, interest in these approaches has grown as clinicians and patients consider ways to balance cancer control with preservation of quality of life.

“The intermediate risk group is still a very challenging philosophical point, because—these are the patients we're going to talk about in VAPOR 2— Gleason 3+4 patients qualify for all 3 of the treatment options,” Mazzarella explained. “Many treatment options is an upside, but it's also a complicated set of choices. That's where the clinical trial option in some settings comes in, or the ablative therapy conversation enters.”

Data from the VAPOR 2 trial, published in the Journal of Urology in July 2026, represent an early analysis of water vapor therapy for prostate tissue ablation.¹ The planned analysis included 110 patients with intermediate-risk localized prostate cancer. Within the targeted ablation area, 91% of patients had resolution of grade group 2 disease, 83% had resolution of the targeted MRI region of interest, and 75% had complete ablation of prostate cancer. Mazzarella noted that these findings apply specifically to the targeted region and do not address cancer that may have been present outside the ablation field.

He added that the full VAPOR 2 data set is expected to inform the cancer-specific analysis.

The Vanquish System is currently cleared in the US for the thermal ablation of targeted prostate tissue via a transurethral approach. The FDA has not evaluated the device for the treatment of any disease, including prostate cancer, nor for any long-term prostate cancer treatment outcomes.

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REFERENCE

1. George A, Giesler E, Mazzarella B, et al. Water vapor therapy for the management of prostate cancer: The VAPOR 2 study initial results of ablative efficacy and toxicity. J Urol. 2026;0(0). doi:10.1097/JU.0000000000005156