Ultrasound-guided Transperineal Prostate Thermal Ablation: Advances in Benign Prostatic Hyperplasia

doi:10.26599/AUDT.2026.260019

Abstract

Abstract:

Benign prostatic hyperplasia (BPH) is a prevalent condition in middle-aged and elderly men, often leading to lower urinary tract symptoms. Although traditional surgical interventions are effective, their limitations include high invasivity and prolonged recovery periods. In recent years, ultrasound-guided transperineal prostate thermal ablation has emerged as a minimally invasive alternative, gaining prominence due to its enhanced precision and low complication rates. This review examines the clinical advancements of three transperineal thermal ablation techniques: transperineal laser ablation (TPLA), transperineal radiofrequency ablation (TPRFA), and transperineal microwave ablation (TPMA). By analyzing recent clinical studies and trials, the procedural methodologies of each technique are elaborated, along with their respective clinical outcomes and associated complications. Furthermore, this work consolidates existing evidence to underscore the role of transperineal thermal ablation in personalized BPH management. This review aims to inform clinical decision-making and expand minimally invasive therapeutic options for BPH treatment.

Key words: Benign prostatic hyperplasia; Transperineal prostate thermal ablation; Transperineal laser ablation; Transperineal radiofrequency ablation; Transperineal microwave ablation

Zhan Cuiping, Han Xiao, Huang Qingbo, Shi Xian-Quan. Ultrasound-guided Transperineal Prostate Thermal Ablation: Advances in Benign Prostatic Hyperplasia. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(3): 127-136.

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Figures/Tables 5

Figure 1

Table 1

Table 2

Table 3

The therapeutic effect of TPLA for BPH."

Study	Follow-up time (Months)	PSA (ng/mL)		IPSS		QoL		Qmax (mL/s)		PVR (mL)		PV (mL)		IIEF-5/ IIEF-15		MSHQ-EjD
Study	Follow-up time (Months)	Baseline	Last follow-up	Baseline	Last follow-up	Baseline	Last follow-up	Baseline	Last follow-up	Baseline	Last follow-up	Baseline	Last follow-up	Baseline	Last follow-up	Baseline	Last follow-up
PSA, prostate specific antigen; IPSS, International Prostate Symptom Score; QoL, quality of life; Qmax, peak urinary flow rate; PVR, postvoid residual urine volume; PV, prostate volume; IIEF-5, International Index of Erectile Function-5; IIEF-15, International Index of Erectile Function-15; MSHQ-EjD, Male Sexual Health Questionnaire-Ejaculatory Dysfunction; N, not reported.
(15)	3	N	N	21.9 ± 6.2	10.7 ± 4.7	4.7 ± 0.6	2.1 ± 1.2	7.6 ± 2.7	13.3± 76.2	199.9 ± 147.3	81.5 ± 97.8	69.8 ± 39.9	54.8 ± 29.8	N	N	N	N
(16)	6	N	N	22.5 ± 5.1	7.7 ± 3.3	4.5 ± 1.1	1.8 ± 1.0	8.0± 3.8	14.3 ± 3.9	89.5 ± 84.6	27.2 ± 44.5	75.0 ± 32.4	60.3 ± 24.5	N	N	N	N
(16)	12	N	N	22.2 ± 4.5	7.0 ± 2.9	4.2 ± 0.6	1. ± 0.9	8.6± 5.2	15.0 ± 4.0	71.7 ± 93.9	17.8± 51.0	87.9± 31.6	58.8 ± 22.9	N	N	N	N
(17)	12	7.3 ± 1.8	2.1 ± 0.8	18.5 ± 5.5	6.2 ± 3.8	5.8 ± 1.4	2. ± 1.1	7.6 ± 4.2	16.2 ± 4.9	138.4 ± 40.8	18.8 ± 8.5	102.42 ± 36.3	48.12 ± 19.2	21± 4	22 ± 3	4.9 ± 3.7	7.7 ± 3.2
(18)	12	N	N	22 (19.5-25.25)	6 (4.25-7)	4 (4-5)	1(1–2)	9 (5-12.5)	20.5 (14.25-23.75)	60 (25-107.5)	30 (5-50)	65 (46.5-81)	41.5 (36.25-55)	22 (16.5-24)	21.5 (17.25– 23.75)	N	N
(19)	6	2.0 ± 1.1	1.7 ± 0.8	18.3 ± 3.9	6.1 ± 2.6	4.1 ± 1.0	1.7 ± 0.8	9.2 ± 3.4	13.9 ± 6.2	81.8 ± 62.	14.0±16.7	N	N	17.8 ± 6.6	18.3 ± 5.7	5.7 ± 4.5	8.6 ± 3.1
(20)	6	N	N	22.7 ± 5.3	9.1 ± 3.2	4.9 ± 1.7	2.3± 1.3	8.5 ± 3.0	15.2 ± 4.8	78.7 ± 58.8	30.3±34.2	70.8 ± 23.8	54.7 ± 20.9	N	N	N	N
(22)	12	4.82 ± 1.8	2.89 ± 1.2	20.8 ± 7.4	8.4 ± 5.9	4.7 ± 1.4	1.2± 0.8	8.6 ± 3.5	16.2 ± 4.3	124.8 ± 115.4	40.6± 53.6	63.6 ± 29.7	42.8 ± 14.2	N	N	N	N
(32)	6	3.0 (1.1-4.0)	N	24.0 (16.0-29.0)	11 (8-15)	5 (3-5)	2 (2-4)	10.2 (8.7-12.0)	15.2 (13.5-18.3)	70 (20-100)	0 (0-5)	49 (37-65)	N	17.0 (15.0– 21.0)	N	29.0 (25.0-30.0)	N
(23)	12	5.0 ± 3.3	N	21.3 ± 5.2	10.9 ± 5.5	4.9 ± 0.9	1.9 ± 1.1	9.7 ± 3.5	14.9 ± 6.0	61.8 ± 58.3	44.2 ± 55.8	65.5 ± 23.0	63.2 ± 20.6	35.4 ± 23.6	31.1 ± 24.4	N	N
(25)	36	N	N	18 (16-21)	12 (10-15)	4 (4-5)	2 (1-2)	8.8 (7.8-10.8)	11.0 (9.0-12.8)	70.0 (33-120)	15.0 (0-25)	41.5 (40.0-54.3)	35.0 (32.0-38.8)	17 (15-21)	17 (15-20)	4 (3-8)	11 (7-12)
(29)	12	4.79 ± 4.63	N	20.14 ± 6.02	10.14 ± 3.21	4.75 ± 0.75	1.50 ± 0.90	8.73 ± 3.77	14.26 ± 3.73	125 ± 68.50	46.88 ± 32.40	66.77 ± 25.28	47.32 ± 13.59	14.84 ± 3.93	14.68 ± 3.92	N	N
(24)	57	N	N	23 (19-26)	8.5 (4-12)	5 (4-5)	1 (0–2)	N	N	108 (38-178)	28.5 (15-50)	66 (48.5-86.5)	61 (37-89)	N	N	N	N
(33)	12	N	N	18 (15-23)	10 (5-16.5)	4 (3-4)	2 (1-3)	9.1 (6.9-12)	13 (8.5-16.9)	90 (50-150)	45 (1.2-87.5)	N	N	N	N	6	9
(26)	12	N	N	N	N	4 (3-5)	2 (1-3)	N	N	N	N	42 (39-70)	N	N	N	N	N
(27)	6	2.2 (0.8-3.8)	2.3 (1.7-2.7)	25 (19-30)	8 (6-11.5)	6 (5-6)	2 (0-4)	8 (5.5-10)	12 (10-13)	50 (15-180)	30 (0-60)	38 (30.5-73)	34 (28-49)	0 (0-6)	N	1 (1-5)	N
(21)	12	7.84 (7.5)	4.5 (4.8)	31 (5)	13 (8)	4 (1)	2 (0.5)	5.5 (1)	13.0 (1.9)	200 (62.5)	85 (10)	68 (20)	40 (11)	9 (7)	8 (9.5)	5 (6)	7 (7)

Table 3

Table 4

References 43

[1]	Infante Hernández S, Gómez Rivas J, Moreno Sierra J. Benign prostatic hyperplasia. Medicina Clinica 2024; 163: 407-414. doi: 10.1016/j.medcli.2024.04.014
[2]	The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Healthy Longevity 2022; 3: e754-e776. doi: 10.1016/S2666-7568(22)00213-6
[3]	Kim EH, Larson JA, Andriole GL. Management of benign prostatic hyperplasia. Annual Review of Medicine 2015; 67: 137-151.
[4]	Plochocki A, King B. Medical treatment of benign prostatic hyperplasia. The Urologic Clinics of North America 2022; 49: 231-238. doi: 10.1016/j.ucl.2021.12.003
[5]	Miernik A, Gratzke C. Current treatment for benign prostatic hyperplasia. Deutsches Arzteblatt International 2020; 117: 843-854.
[6]	Yu Y, Lou G, Shen C, Guan S, Wang W, Yang B. Technical aspects of transurethral plasmakinetic enucleation and resection of the prostate for benign prostatic hyperplasia. Minimally Invasive Therapy & Allied Technologies: MITAT: Official Journal of the Society For Minimally Invasive Therapy 2016; 26: 44-50.
[7]	Ottaiano N, Shelton T, Sanekommu G, Benson CR. Surgical complications in the management of benign prostatic hyperplasia treatment. Current Urology Reports 2022; 23: 83-92. doi: 10.1007/s11934-022-01091-z
[8]	Nguyen D-D, Li T, Ferreira R, Baker Berjaoui M, Nguyen A-LV, Chughtai B, et al. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer and Prostatic Diseases 2023; 27: 22-28. doi: 10.1038/s41391-023-00669-z
[9]	Sapoval M, Thiounn N, Descazeaud A, Déan C, Ruffion A, Pagnoux G, et al. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. The Lancet Regional Healt 2023; 31: 100672. doi: 10.1016/j.lanepe.2023.100672
[10]	Sessa F, Polverino P, Siena G, Bisegna C, Lo Re M, Spatafora P, et al. Transperineal laser ablation of the prostate (TPLA) for lower urinary tract symptoms due to benign prostatic obstruction. Journal of Clinical Medicine 2023; 12: 793.
[11]	Bartoletti R, Cai T, Tinacci G, Longo I, Ricci A, Massaro MP, et al. Transperineal microwave thermoablation in patients with obstructive benign prostatic hyperplasia: a phase I clinical study with a new mini-choked microwave applicator. Journal of Endourology 2008; 22: 1509-1517.
[12]	Nunes TF, Rocha RD, Ilgenfritz BRW, Stefanini FS, Fornazari VAV, Mariotti GC, et al. Ultrasound-guided transperineal prostate thermal ablation (TPTA) for benign prostatic hyperplasia: Feasibility of an outpatient procedure using radiofrequency ablation. CardioVascular and Interventional Radiology 2025; 48: 1455-1466.
[13]	Alberti A, Lo Re M, Nicoletti R, Polverino P, Cadenar A, Ciaralli E, et al. Transperineal laser ablation in the management of benign prostatic hyperplasia: an updated systematic review and pooled analysis. Prostate Cancer and Prostatic Diseases 2026; 29: 222-238.
[14]	Cocci A, Pezzoli M, Bianco F, Blefari F, Bove P, Cornud F, et al. Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project. Asian Journal of Urology 2023; 11: 271-279.
[15]	Patelli G, Ranieri A, Paganelli A, Mauri G, Pacella CM. Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: A feasibility study. Cardiovascular and Interventional Radiology 2017; 40: 1440-1446. doi: 10.1007/s00270-017-1662-9
[16]	Pacella CM, Patelli G, Iapicca G, Manenti G, Perretta T, Ryan CP, et al. Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study. Prostate Cancer and Prostatic Diseases 2020; 23: 356-363.
[17]	Manenti G, Perretta T, Calcagni A, Ferrari D, Ryan CP, Fraioli F, et al. 3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia. European Radiology Experimental 2021; 5: 41. doi: 10.1186/s41747-021-00239-9
[18]	Frego N, Saita A, Casale P, Diana P, Contieri R, Avolio PP, et al. Feasibility, safety, and efficacy of ultrasound-guided transperineal laser ablation for the treatment of benign prostatic hyperplasia: a single institutional experience. World Journal of Urology 2021; 39: 3867-3873.
[19]	de Rienzo G, Lorusso A, Minafra P, Zingarelli M, Papapicco G, Lucarelli G, et al. Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction. European Urology 2021; 80: 673-674.
[20]	Cai H-J, Fang J-H, Kong F-L, Xu C-K, Chen C-H, Wang W, et al. Ultrasound-guided transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a new minimally invasive interventional therapy. Acta Radiologica (Stockholm, Sweden: 1987) 2022; 63: 553-558.
[21]	Özlülerden Y, Küçüker K, Çelen S, Duran MB, Başer A, Yagci AB, et al. Real-world clinical outcomes of transperineal laser ablation in BPH: A 12-month retrospective analysis. Journal of Clinical Medicine 2025; 14: 6079. doi: 10.3390/jcm14176079
[22]	Laganà A, Di Lascio G, Di Blasi A, Licari LC, Tufano A, Flammia RS, et al. Ultrasound-guided SoracteLite^TM transperineal laser ablation (TPLA) of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH): a prospective single-center experience. World Journal of Urology 2023; 41: 1157-1162.
[23]	van Kollenburg R, van Riel L, Bloemen P, de Reijke T, Beerlage H, de Bruin D, et al. Transperineal laser ablation as treatment for benign prostatic obstruction: Safety, feasibility and functional outcomes-A pilot study. BJUI Compass 2023; 5: 52-59.
[24]	Patelli G, Altieri VM, Ierardi AM, Carnevale A, Chizzoli E, Baronchelli F, et al. Transperineal laser ablation of the prostate for symptomatic benign prostatic hyperplasia: Long-term follow-up in 40 patients. Journal of Vascular and Interventional Radiology: JVIR 2024; 35: 1187-1193.
[25]	Minafra P, De Rienzo G, Gerbasi S, Cindolo L, Battaglia M, Ditonno P. Three years outcomes of transperineal laser ablation of the prostate. Minerva Urology and Nephrology 2023; 75: 471-478.
[26]	Polverino P, Lo Re M, Saladino M, Pecoraro A, Moscardi L, Rivetti A, et al. Could transperineal interstitial laser ablation of the prostate be the right option for highly-comorbid patients with lower urinary tract symptoms due to benign prostatic obstruction? A preliminary single-center experience focusing on functional and safety outcomes. Minerva Urology and Nephrology 2024; 76: 646-649.
[27]	Destefanis P, Sibona M, Vitiello F, Vercelli E, Micai L, Montefusco G, et al. Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction. Prostate Cancer and Prostatic Diseases 2023; 27: 693-699. doi: 10.1038/s41391-023-00736-5
[28]	van Kollenburg RAA, van Riel LAMJG, Oddens JR, de Reijke TM, van Leeuwen TG, de Bruin DM. Contrast-enhanced ultrasound imaging following transperineal laser ablation for lower urinary tract symptoms. Urology 2024; 198: 141-147. doi: 10.1016/j.urology.2024.11.070
[29]	Canat HL, Gurbuz C, Bozkurt M. Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study. International Urology and Nephrology 2023; 55: 2747-2752. doi: 10.1007/s11255-023-03717-8
[30]	Pacini M, Zucchi A, Salonia A, Sollazzi E, Macrì G, Volterrani R, et al. Short term results after minimally invasive treatments for benign prostatic enlargement: the first randomized trial comparing transperineal laser ablation and water vapor ablation. Prostate Cancer and Prostatic Diseases 2025; 28: 978-984. doi: 10.1038/s41391-025-00972-x
[31]	Zucchi A, Bartoletti R, Antonov P, Salonia A, Ivanov A, Macrì G, et al. Preserving erectile and ejaculatory function in patients undergoing minimally invasive techniques: the first randomized clinical trial comparing convective water vapor ablation and transperineal laser ablation. The Journal of Sexual Medicine 2025; 22: 1447-1454. doi: 10.1093/jsxmed/qdaf150
[32]	Bertolo R, Iacovelli V, Cipriani C, Carilli M, Vittori M, Antonucci M, et al. Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial. BJU International 2023; 132: 100-108.
[33]	Lo Re M, Polverino P, Rivetti A, Pecoraro A, Saladino M, Pezzoli M, et al. Transperineal laser ablation (TPLA) of the prostate for benign prostatic obstruction: the first 100 patients cohort of a prospective, single-center study. World Journal of Urology 2024; 42: 402.
[34]	Lorenzoni V, Palla I, Manenti G, Ditonno P, de Reijke TM, Turchetti G. Standard approach and future perspective for the management of benign prostatic hyperplasia from a health-economics point of view: the role of transperineal laser ablation. Front Urol 2023; 3: 1100386. doi: 10.3389/fruro.2023.1100386
[35]	Nunes TF, Szejnfeld D, Viana PCC, Stefanini FS, Fornazari VAV, Leite TFdO, et al. Image-guided, urethra-sparing transperineal radiofrequency ablation for benign prostatic hyperplasia: a prospective bicenter outpatient study. Diagnostic and Interventional Radiology 2026.
[36]	Lubner MG, Brace CL, Hinshaw JL, Lee FT, Jr. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21: S192-203. doi: 10.1016/j.jvir.2010.04.007
[37]	Wagrell L, Schelin T, Bolmsjö MB, Mattiasson A. Aspects on transurethral microwave thermotherapy of benign prostatic hyperplasia. Tech Urol 2000; 6: 251-255.
[38]	Türk Y, Devecioğlu İ, Çilesiz NC, Nuhoğlu B. Transperineal microwave thermoablation for benign prostatic hyperplasia-related lower urinary tract symptoms in an elderly patient. Diagnostic and Interventional Radiology (Ankara, Turkey) 2024; 31: 141-145.
[39]	Peter Ka-Fung Chiu* K-LL, Chi-Hang Yee, Jeremy Yuen-Chun Teoh, Ho Fai Wong, Angel W. Y. Kong, Chi-Fai Ng, Hong Kong, Hong Kong. Transperineal targeted microwave ablation (TMA) with 3D ultrasound-guidance for treating benign prostatic hyperplasia: a safety and feasibility study (BETTY). The Journal of Urology 2024; 211: e758.
[40]	Tzelves L, Nagasubramanian S, Pinitas A, Juliebø-Jones P, Madaan S, Sienna G, et al. Transperineal laser ablation as a new minimally invasive surgical therapy for benign prostatic hyperplasia: a systematic review of existing literature. Therapeutic Advances In Urology 2023; 15: 17562872231198634.
[41]	Sciacqua LV, Vanzulli A, Di Meo R, Pellegrino G, Lavorato R, Vitale G, et al. Minimally invasive treatment in benign prostatic hyperplasia (BPH). Technology In Cancer Research & Treatment 2023; 22: 15330338231155000.
[42]	Cornud F, Walser EM, de Bie KC, Lefevre A, Galiano M. Laser-focused ablative therapy for prostate cancer and benign prostatic hyperplasia: A review of current applications and future directions. Diagnostic and Interventional Imaging 2025; 106: 289-298. doi: 10.1016/j.diii.2025.04.001
[43]	Liu R, Duan S, Cao H, Cao G, Chang Z, Zhang Y, et al. A pilot study of the shapes of ablation lesions in the canine prostate by laser, radiofrequency and microwave and their clinical significance. Plos One 2020; 15: e0223229.

Study	Country	Year	Research type	Number of patients	Inclusioncriteria
Study	Country	Year	Research type	Number of patients	Age (years)	PV (mL)	IPSS	Qmax (ml/s)	PVR (mL)
PV, prostate volume; IPSS, International Prostate Symptom Score; Qmax, peak urinary flow rate; PVR, postvoid residual urine volume; N, not reported.
(15)	Italy	2017	prospective	18	> 50	≥ 30	≥ 13	≥ 5 to ≤ 15	N
(16)	Italy	2020	retrospective	160	> 50	> 30	≥ 12	< 15	< 400
(17)	Italy	2021	prospective	44	≥ 50	≥ 30	≥ 12	N	N
(18)	Italy	2021	prospective	22	≥ 45	30-100	≥ 8	≤ 15	≤ 150
(19)	Italy	2021	prospective	21	40-90	< 100	≥ 12	N	N
(20)	China	2022	retrospective	20	> 50	≥ 30	≥ 12	≤ 15	≥ 50 and ≤ 400
(22)	Italy	2023	prospective	63	N	≤ 85	N	N	N
(32)	Italy	2023	prospective	51	18-75	< 100	≥ 10	< 15	N
(23)	Netherlands	2023	prospective	20	≥ 40	30-120	N	5-15	N
(25)	Italy	2023	prospective	21	N	30-100	≥ 12	≤ 15	N
(29)	Turkey	2023	prospective	50	≥ 50	N	> 12	≤ 15	N
(24)	Italy	2024	prospective	40	50	≥ 30	≥ 13	≥ 5 to ≤ 15	≥ 50
(33)	Italy	2024	prospective	100	45	30-100	≥ 8	N	N
(26)	Italy	2024	prospective	23	N	30-100	≥ 8	N	N
(27)	Italy	2024	prospective	40	N	N	> 8	< 15	N
(21)	Türkiye	2025	retrospective	53	≥ 50	N	≥ 13	≤ 15	N

Study	Number of fibres per lobe	Distance from another needle (mm)	Distance from bladder (mm)	Distance from urethra (mm)	Distance from prostatic capsule outer edge (mm)	Ablation time (min)	operative time (min)	Total energy (J)	Hospitalization time (Days)
N, not reported.
(15)	22% one 78% two	15-20	15	8	N	15.9 ± 3.9	43.3 ± 8.7	10,522 ± 3290.5	1.5 ± 0.4
(16)	one or two	8-10	15	8-10	10	23.4 ± 10.2	44.1 ± 12.9	6616.2 ± 3880.4	1.8 ± 0.4
(17)	one or two	8-10	15	10	N	N	28.2 ± 10.6 (21-75)	N	1
(18)	54.5% one 45.5% two	10-15	15	10	10	17.2 (10.0-18.9)	N	N	1
(19)	one to two	10-15	15	8	8	N	36.0 ± 9.5	N	0.9 ± 0.2
(20)	one to two	N	15	8-10	N	42.6 ± 9.9	60.9 ± 10.8	7179.2 ± 2815.7	1.5 ± 0.5
(22)	1.82 ± 0.4	10	15	8-10	8-10	13.0 ± 1.95	48.8 ± 14.3	8,261.6 ± 3,280.1	1
(32)	One or two	10-15	15	8	8	N	35 (30-55)	N	2 (2-3)
(23)	One or two	N	15	8	8	17.2 ± 6.3	59 ± 14.0	8271 ± 3259	1
(25)	one or two	N	15	8	8	N	N	N	N
(29)	one or two	N	15	8	8	N	16 ± 2.35	N	0.67 ± 0.49
(24)	1.8 ± 0.4	N	N	N	N	17.3 ± 4.4	43.3 ± 8.7	11,214.0 ± 4,097.1	2
(33)	one or two	N	15	8	N	N	N	2800 (2400-3100)	1-2
(26)	one or two	N	N	N	N	N	N	2800 (2400-3200)	1
(27)	one or two	N	N	N	N	17.5 (8.5-18.5)	42.5 (35-50)	7202.5 (3652-7227.5)	1
(21)	one or two	10	15	10	10	N	26 (10.5)	7200 (3600)	N

Parameter	TPLA	TPRFA	TPMA
TPLA, transperineal laser ablation; TPRFA, transperineal radiofrequency ablation; TPMA, transperineal microwave ablation
Energy source	Laser	Radiofrequency	Microwave
Primary mechanism	Photothermal conversion → coagulative necrosis	Resistive heating → coagulative necrosis	Dielectric hysteresis → coagulative necrosis
Ablation device	300 μm optical fibers via 21G needles	17G RFA needle with 10-mm active tip	15G coaxial needles with microwave antenna
Typical fiber/needle configuration	1-2 fibers per lateral lobe; additional for median lobe	Single needle, sequentially repositioned	3 needles (midline, right, left)
Safety margins	Urethra 8-10 mm; bladder ≥ 15 mm; capsule 8-10 mm	Urethra ≥ 8 mm; bladder ≥ 5 mm	Urethra ≥ 5 mm; capsule > 1 cm; rectal wall ≥ 0.5 cm
Anesthesia	Local or periprostatic anesthesia with conscious sedation	Unconscious sedation + perineal/periprostatic block	Local (lidocaine) or general/spinal