Aliya Pulsed Electric Field (PEF) Therapy for Prostate Cancer
Aliya pulsed electric field therapy, or Aliya PEF, is an emerging focal therapy that uses high-voltage electrical pulses to ablate targeted prostate tissue. Unlike HIFU and cryoablation, which rely on heat or freezing, Aliya PEF is primarily a non-thermal treatment. The goal is to treat the planned cancer-bearing region while limiting injury to nearby structures such as the urethra, bladder neck, neurovascular bundles, and rectum.
Aliya PEF is delivered through a thin needle placed through the perineum under image guidance. Treatment is planned using MRI/ultrasound fusion so the ablation zone can be matched to the patient's tumor location, prostate anatomy, and safety margins. Dr. Tan offers Aliya PEF for carefully selected patients as part of a personalized focal therapy program at NYU Langone Health.
First in NYU Langone and in Manhattan
Dr. Tan was the first surgeon at NYU Langone Health and in Manhattan to perform Aliya pulsed electric field ablation for prostate cancer.
"Aliya PEF gives us another way to treat selected prostate tumors without heat, freezing, radiation, or removal of the entire prostate. The goal is simple: treat the cancer while protecting the structures that matter most."- Dr. Wei Phin Tan, MD, MHS, FACS
What Makes Aliya PEF Different?
Most prostate cancer treatments destroy tissue using one of several mechanisms. Surgery removes the prostate. Radiation damages cancer DNA. HIFU uses heat. Cryoablation uses freezing.
Aliya PEF works differently. It delivers short electrical pulses that disrupt cell membranes and ablate tissue without relying primarily on thermal injury. Because it is non-thermal, Aliya PEF may be useful for small, carefully selected tumors located near critical structures where heat or freezing may be less ideal.
This does not mean Aliya PEF has no risk. It is still a real cancer treatment, and careful patient selection is essential.
Who May Be a Candidate?
Aliya PEF may be considered for carefully selected men with localized prostate cancer when the tumor can be clearly identified and safely targeted.
Potential candidates may include men with:
- Carefully selected low- or intermediate-risk prostate cancer
- A small MRI-visible lesion or defined region of disease confirmed by biopsy mapping
- A tumor close to critical structures such as the urethra, bladder neck, neurovascular bundles, or rectum
- Cancer that can be treated with an appropriate safety margin
- A strong preference to preserve urinary and sexual function
- An interest in focal therapy rather than whole-gland treatment
- An understanding that Aliya PEF is newer than surgery, radiation, HIFU, and cryoablation
Aliya PEF is not appropriate for every patient. Men with extensive bilateral disease, very high-risk features, metastatic disease, or cancer that cannot be safely targeted may be better served by active surveillance, surgery, radiation, systemic therapy, another focal therapy, or a clinical trial.
How the Procedure Works
Aliya PEF is performed under general anesthesia as an outpatient procedure. A thin treatment needle is placed through the perineum into the planned treatment zone. MRI/ultrasound fusion guidance is used to match the treatment plan to the patient's MRI-visible lesion and biopsy map.
Electrical pulses are then delivered to create a planned ablation zone. The goal is to cover the tumor and a safety margin while limiting injury to the urethra, nerves, bladder neck, rectum, and uninvolved prostate tissue.
Most patients go home the same day with a temporary urinary catheter. Catheter duration depends on the treatment zone, swelling, baseline urinary function, and prostate anatomy.
Key Advantages
- Non-thermal focal therapy
- No prostate removal
- No radiation
- No incision
- Outpatient, same-day procedure
- Designed to preserve urinary and sexual function when anatomy is favorable
- May be useful for small lesions near critical structures
- Can be considered alongside HIFU and cryoablation as part of a personalized focal therapy strategy
Aliya PEF vs. HIFU vs. Cryoablation
| Factor | Aliya PEF | HIFU | Cryoablation |
|---|---|---|---|
| Energy Type | Pulsed electric fields | Focused ultrasound heat | Freezing |
| Thermal Effect | Primarily non-thermal | Heat-based | Cold-based |
| Needle Placement | Yes, through the perineum | No needles; transrectal probe | Yes, through the perineum |
| Anesthesia | General anesthesia | General anesthesia | General anesthesia |
| Best Use Case | Carefully selected, small lesions where a non-thermal approach may be advantageous, especially near the urethra, bladder neck, neurovascular bundles, or rectum | Posterior or mid-gland MRI-visible lesions where heat-based treatment can safely cover the target | Larger targets, anterior lesions, or salvage settings where probe-based freezing provides strong coverage |
| Recovery | Outpatient with temporary catheter | Outpatient with temporary catheter | Outpatient with temporary catheter |
| Follow-Up | PSA, MRI, and repeat biopsy when indicated | PSA, MRI, and repeat biopsy when indicated | PSA, MRI, and repeat biopsy when indicated |
What Are the Risks?
Aliya PEF is designed to limit injury to surrounding structures, but it is still a prostate cancer treatment. Possible side effects include temporary urinary urgency, frequency, burning, weak stream, urinary retention, blood in the urine, pelvic discomfort, infection, erectile dysfunction, incomplete ablation, or cancer recurrence.
Because the prostate remains in place, patients still need close surveillance after treatment. Follow-up usually includes PSA testing, prostate MRI, and sometimes repeat biopsy to confirm treatment response.
How Strong Is the Evidence?
Aliya PEF is promising, but prostate experience remains early compared with surgery, radiation, HIFU, and cryoablation. The Aliya system is FDA-cleared for surgical ablation of soft tissue, but it is not specifically cleared to treat, cure, prevent, or mitigate prostate cancer.
Published prostate experience with Aliya PEF is currently limited. Early case-level experience has described transperineal Aliya PEF for biopsy-proven local recurrence after radiation therapy.
For that reason, Aliya PEF should be presented as an emerging focal therapy option for highly selected patients, not as a replacement for established treatments in all men.
Frequently Asked Questions
Is Aliya PEF the same as HIFU or cryoablation?
Is Aliya PEF the same as NanoKnife?
Is Aliya PEF FDA-cleared?
How long does Aliya PEF take?
Will I need a catheter?
What follow-up is needed?
Can I still have surgery or radiation later?
Bottom Line
Aliya PEF is not a one-size-fits-all prostate cancer treatment. It is another tool in the focal therapy toolbox. For the right patient, it may allow precise treatment of a small, localized prostate cancer while preserving urinary and sexual function. For the wrong patient, active surveillance, surgery, radiation, HIFU, cryoablation, or a clinical trial may be the better choice.
Selected Evidence
Aliya PEF clinical experience for prostate cancer is early. Dr. Tan's institutional case experience is in preparation for peer-reviewed publication. Selected related published work on focal therapy and patient selection includes:
- Deivasigamani S, Kotamarti S, Rastinehad AR, et al. (incl. Tan WP). Primary whole-gland ablation for localized prostate cancer: Focal Therapy Society best practice. European Urology. 2023. PMID 37419773
- Tan WP, Wysock JS, Lepor H. Partial gland ablation for prostate cancer, where are we? Nature Reviews Urology. 2023. PMID 36434111
Full publication list pulled live from PubMed on the Publications page.