Prostate ablation for the management of localized prostate cancer.

Abstract

Purpose: To evaluate the oncological and genitourinary outcomes of various forms of prostate ablation for localized prostate cancer.

Methods: A prospectively managed database included men with localized prostate cancer who underwent prostate ablation during January 2018-August 2023. Patients received either whole or partial-gland ablation using 1 of 3 energy modalities: cryotherapy, High Intensity Focused Ultrasound (HIFU), or Irreversible electroporation (IRE). The primary endpoints included biochemical recurrence (BCR), imaging failure (IF) and pathological failure (PF). The secondary endpoints included complication rate at 30 days and genitourinary function.

Results: 150 consecutive patients were included, of them 49 (32.7%) underwent whole-gland therapy and 101 (67.3%) underwent partial-gland therapy. The whole-gland therapy subgroup included cryoablation (39, 79.6%) and HIFU (10, 20.4%) and the partial-gland therapy subgroup included cryoablation (50, 49.5%), HIFU (30, 29.7%) and IRE (21, 20.8%). The median follow-up time was 32.6 months (IQR, 19.2-47.0) and 14.8 months (IQR, 9.5-31.9) in the whole-gland and partial-gland therapy subgroups, respectively. The rate of PF was 6.1% and 16.8% in the whole and partial gland groups, respectively. Whole-gland cryoablation had the most prominent positive impact on AUA-SS score and negative impact on SHIM score. Among patients undergoing partial gland ablation there was no significant impact on urination and erections at 12 months and 90% of potent men retained their potency. Approximately one-third of the patients experienced minor postoperative complications within 30 days.

Conclusion: Our findings conclude that ablation is a safe treatment option for localized prostate cancer, with satisfactory oncological outcomes and minimal short-intermediate-term morbidity.

Patient summary: In this study we looked at whole- and partial-gland ablation therapies for localized prostate cancer and found satisfactory oncological outcomes and minimal impact on urinary and sexual function with short-intermediate-term follow-up.