Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement

• Published in: European urology 2023-12, Vol.84 (6), p.547-560
• Main Authors: Deivasigamani, Sriram, Kotamarti, Srinath, Rastinehad, Ardeshir R., Salas, Rafael Sanchez, de la Rosette, J.J.M.C.H., Lepor, Herbert, Pinto, Peter, Ahmed, Hashim U., Gill, Inderbir, Klotz, Laurence, Taneja, Samir S., Emberton, Mark, Lawrentschuk, Nathan, Wysock, James, Feller, John F., Crouzet, Sebastien, Kumar M., Praveen, Seguier, Denis, Adams, Eric S., Michael, Zoe, Abreu, Andre, Jack Tay, Kae, Ward, John F., Shinohara, Katsuto, Katz, Aaron E., Villers, Arnauld, Chin, Joseph L., Stricker, Phillip D., Baco, Eduard, Macek, Petr, Ahmad, Ardalan E., Chiu, Peter K.F., Crawford, E. David, Rogers, Craig G., Futterer, Jurgen J., Rais-Bahrami, Soroush, Robertson, Cary N., Hadaschik, Boris, Marra, Giancarlo, Valerio, Massimo, Chong, Kian Tai, Kasivisvanathan, Veeru, Tan, Wei Phin, Lomas, Derek, Walz, Jochen, Guimaraes, Gustavo Cardoso, Mertziotis, Nikos I., Becher, Ezequiel, Finelli, Antonio, Kasraeian, Ali, Lebastchi, Amir H., Vora, Anup, Rosen, Mark A., Bakir, Baris, Arcot, Rohit, Yee, Samuel, Netsch, Christopher, Meng, Xiaosong, de Reijke, Theo M., Tan, Yu Guang, Regusci, Stefano, Benjamin, Tavya G.R., Olivares, Ruben, Noureldin, Mohamed, Bianco, Fernando J., Sivaraman, Arjun, Kim, Fernando J., Given, Robert W., Dason, Shawn, Sheetz, Tyler J., Shoji, Sunao, Schulman, Ariel, Royce, Peter, Shah, Taimur T., Scionti, Stephen, Salomon, Georg, Laguna, Pilar, Tourinho-Barbosa, Rafael, Aminsharifi, Alireza, Cathelineau, Xavier, Gontero, Paolo, Stabile, Armando, Grummet, Jeremy, Ledbetter, Leila, Graton, Margaret, Stephen Jones, J., Polascik, Thomas J.
• Format: Article
• Language: English
• Subjects: Ablation therapy; Best practice statement; Cryosurgery - adverse effects; Cryotherapy; Focal Therapy Society; Functional outcomes; High-intensity focused ultrasound; Humans; Male; Oncological outcomes; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms - surgery; Retrospective Studies; Treatment Outcome; Whole-gland ablation
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2023.06.013

Localized prostate cancer can be treated effectively with minimally invasive whole-gland ablation with comparable intermediate- to long-term oncological control with excellent pad-free continence rate at 1 yr. Treatment decisions consistent with patient values and preferences should be encouraged. Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up. To evaluate the real-world data on the mid- to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings. We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed. Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence–free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71–79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4–98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively. The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate- to long-term oncologi