The great ablation debate
Cryoablation, microwave, SBRT and histotripsy go head-to-head as specialists argue what works best—and for whom.
Minimally invasive tumor ablation techniques are gaining increasing attention as alternatives to surgery for patients with early‑stage kidney cancer, and urologists are set to debate the latest options at the 2026 AUA Annual Meeting.
According to Jeffrey A. Cadeddu, MD, FRCS, moderator of the session Survivor Debate: Best Ablation Modality for Small Renal Masses, today’s many ablation therapies offer patients additional treatment choices, particularly for those with small, stage‑one renal tumors. Dr. Cadeddu is a professor of urology at the University of Texas Southwestern Medical School in Dallas. Although surgery remains the standard approach, he said, ablation techniques offer a less invasive option with lower risk and faster recovery.
“Ablation isn’t necessarily preferred over surgery—it’s another option,” Dr. Cadeddu said. “The advantage is that it avoids many of the risks associated with surgery, including bleeding, anesthesia, kidney injury and prolonged recovery.”
One of the key advantages of ablation is that it reduces morbidity, Dr. Cadeddu said. Even with robotic surgery, there is a risk of bleeding and kidney injury as well as those risks associated with anesthesia. Often, ablations are performed as outpatient procedures. They generally do not require a hospital stay, and some of the technologies that will be debated during the session do not require anesthesia, he said.
However, ablation is not appropriate for every patient. According to Dr. Cadeddu, eligibility depends largely on tumor size and location. The procedures discussed at the session are intended for tumors smaller than three centimeters, all of which are classified as stage‑one cancers.
One trade‑off with ablation, he said, is a small risk of incomplete treatment or recurrence, because the tumor is destroyed rather than surgically removed. Dr. Cadeddu noted that incomplete treatment or recurrence rates generally range from 5% to 10%, depending on tumor characteristics and the technology used.
“Many surgeons would have a bias against ablation because of the risk of recurrence,” Dr. Cadeddu said. “But, if the cancer returns, you can always do surgery or, better yet, you can do another ablation with success rates, then matching surgery.”
The session will feature a debate among specialists representing four ablation modalities: cryoablation, microwave ablation, stereotactic body radiation therapy (SBRT) and histotripsy, an emerging ultrasound‑based technique. Although cryoablation and microwave ablation are well-established, needle-based approaches, SBRT and histotripsy are newer, fully noninvasive technologies that require no incisions or needles, Dr. Cadeddu said.
During the session, speakers will evaluate a clinical case and argue why their modality is best suited for treatment. Audience members will participate by voting, eliminating options and, ultimately, selecting a preferred approach based on the evidence presented.
Dr. Cadeddu said the debate reflects a broader shift in cancer care toward offering patients multiple effective treatment options tailored to their needs.
