Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low and Intermediate Risk Prostate Cancer: Oncologic and Functional Outcomes

García‐Barreras, Silvia; Sánchez-Salas, Rafael; Sivaraman, Arjun; Barret, Éric; Secín, Fernando P.; Nunes‐Silva, Igor; Linares-Espinós, Estefanía; Rozet, François; Galiano, Marc; Cathelineau, Xavier

doi:10.1016/j.juro.2017.08.076

Cited by 30 publications

(20 citation statements)

References 28 publications

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“…FT is delivered by a variety of energy modalities including: photothermal ablation, high‐intensity focussed ultrasound (HIFU), and cryotherapy, amongst others . FT has been shown to have acceptable early term disease‐free control rates in well‐selected patients .…”

Section: Introductionmentioning

confidence: 99%

Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

Herrera-Cáceres

Salgado-Sanmamed

et al. 2020

BJU International

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Objectives To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). Patients and Methods A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. Results In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high‐intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T‐stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow‐up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR‐free survival (hazard ratio 6.624, 95% confidence interval 2.243–19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5–9.5) and 23.5 (15.75–25) respectively, while in the final follow‐up the median (IQR) values were 7 (3.5–11) and 6 (5–12.25), respectively (P = 0.088 and P < 0.001). At last follow‐up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. Conclusions sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.

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Section: Introductionmentioning

confidence: 99%

Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

Herrera-Cáceres

Salgado-Sanmamed

et al. 2020

BJU International

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“…A comparative analysis has looked into oncological and functional outcomes of partial gland ablation (PGA) vs. RARP and showed that PGA renders better preservation of continence and potency after a mean follow-up of 38 months. However, these improved outcomes came at the cost of a higher rate of treatment failures and the need for salvage therapy after PGA 27 .…”

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confidence: 99%

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Schmid

Schindele

Mortezavi

et al. 2020

Urologic Oncology: Seminars and Original Investigations

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Purpose To investigate focal therapy using High Intensity Focused Ultrasound (HIFU) for the treatment of localized prostate cancer (CaP), we analyzed the safety and complications of this procedure. Methods Patients (pts) eligible for this multicenter prospective cohort study suffered from low to intermediate risk localized CaP with no prior treatment. After tumor identification on multiparametric MRI and in prostate biopsy, the lesions were treated with HIFU observing a safety margin of 8 to 10 mm. Adverse events (AE) after 30 and 90 days, as well as the required interventions were assessed and stratified for treatment localizations. Results Of the 98 men included in the study in two European centers, 35 (35.7%) experienced AEs in the first 30 days after HIFU intervention with Clavien-Dindo grade II: 15 pts (15.3%) had a postoperative urinary tract infection and 26 pts (26.5%) a urinary retention. Four pts (4.1%) underwent subsequent intervention (Clavien-Dindo grade IIIa/b). The number of late postoperative complications occurring between 30 and 90 days after intervention was low (2.0%). The highest complication rate was associated with tumors located at the anterior base (50.0%). The inclusion of the urethra in the ablation zone led to AEs in 20 out of 41 cases (48.8%) and represented a significant risk factor for complications within 30 days (odds ratio = 2.53; 95% confidence interval: 1.08-5.96; P = 0.033). Conclusions Focal therapy of CaP lesions with a robotic HIFU-probe is safe and renders an acceptable rate of minor early AEs. The inclusion of the urethra in the ablation zone leads to an increase in early complications and should be avoided whenever possible.

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“…The results of the SMRW cohort supported the validity of the results. Garcia-Barreras et al (10) also reported an inferior efficacy of CA. They compared the oncological outcomes between 236 partial gland CA patients and 472 matched robot-assisted RP patients.…”

Section: Discussionmentioning

confidence: 97%

“…Some single-arm case series showed that CA has a favorable short-intermediate term oncological efficacy in patients with clinically low-intermediate risk PCa (8,9). Furthermore, other studies comparing radical prostatectomy (RP) and CA reported comparable oncological outcomes between the two interventions (10,11). However, given the lack of comparative study of CA vs. RP with mid-long followup period, significant uncertainties remain in considering CA as an alternative strategy to radical prostatectomy (RP) for localized PCa.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Oncological Outcomes of Cryoablation vs. Radical Prostatectomy in Low-Intermediate Risk Localized Prostate Cancer

et al. 2020

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Purpose: To compare the oncologic outcomes of cryoablation (CA) and radical prostatectomy (RP) in patients with low-and intermediate-risk localized prostate cancer (PCa). Materials and Methods: PCa patients who received CA or RP between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable Cox proportional hazard analysis was used to compare the prostate cancer-specific survival (CSS) and overall survival (OS). We conducted 1:3 propensity score matching and adjusted standardized mortality ratio weighting (SMRW) to balance the clinicopathological characteristics. Results: Ninety-seven thousand seven hundred eighty-three patients were identified after preliminary screening. After matching, the CA and RP groups included 1,942 and 5,826 patients and had median follow-up periods of 85 and 72 months, respectively. CA had lower CSS and OS rates (hazard ratio [HR], 2.07; P = 0.007; HR, 2.09; P < 0.001, respectively) than did RP, which was consistent in the SMRW model (CSM: HR, 2.66; P < 0.001; OS: HR, 2.29; P < 0.001). The 10-years CSS and OS for CA vs. RP were 98.1 vs. 99.2% and 61.3 vs. 79.9%, respectively. Conclusions: In patients with low-to intermediate-risk localized PCa, CA had lower CSS rates than did RP. However, the high 10-years CSS rates indicated that CA could be an option for those who are not RP candidates. Further high-quality trials are needed to confirm and expand our findings.

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Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low and Intermediate Risk Prostate Cancer: Oncologic and Functional Outcomes

Abstract: In select patients with organ confined prostate cancer partial gland ablation offered good oncologic control with fewer adverse effects that required additional treatments. Potency and continence appeared to be better preserved after partial gland ablation.

Cited by 30 publications

References 28 publications

Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Comparing the Oncological Outcomes of Cryoablation vs. Radical Prostatectomy in Low-Intermediate Risk Localized Prostate Cancer

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