Prostate ablation for the management of localized prostate cancer

• Published in: Urologic oncology 2024-11
• Main Authors: Sidana, Abhinav, Lazarovich, Alon, Tayebi, Shima, Huron, Alex, Blank, Fernando, Tobler, Juliana, Verma, Sadhna, Hsu, Wei-Wen
• Format: Article
• Language: English
• Subjects: Cryoablation; Focal therapy; High-frequency focused ultrasound; Irreversible electro-corporation; Multiparametric magnetic resonance imaging; Prostate cancer; whole-gland therapy
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2024.11.009

•Our study explores the efficacy of prostate ablation, both whole-gland and partial-gland ablation, as an emerging treatment for localized prostate cancer, emphasizing its potential in reducing quality of life burdens compared to traditional radical treatments.•The choice of prostate ablation modality as well as the choice between whole and partial gland ablation should be tailored based on the patient's and tumor's characteristics.•The study reports promising short- to mid-term outcomes for prostate ablation with good genitourinary and oncological outcomes- pathological failure rates of 6.1% for whole-gland ablation and 16.8% for partial-gland ablation.•Approximately one-third of patients experienced minor complications (Clavien-Dindo 1-2) within 30 days, highlighting the safety of these ablation techniques. To evaluate the oncological and genitourinary outcomes of various forms of prostate ablation for localized prostate cancer. 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. 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. Our findings conclude that ablation is a safe treatment o