Presented by: Sriram Deivasigamani MBBS
Duke University Medical Center

Introduction

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 real-world data on mid-to-long-term oncological and functional outcomes of whole-gland cryoablation and HIFU (High Intensity Focused Ultrasound) in patients with clinically localized PCa.

Materials

We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.  As endpoints, baseline clinical characteristics, 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.

Results

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Twenty-nine studies were identified, including 14 cryoablation and 15 HIFU with median follow-up of 72 months. Most were retrospective (n=23), with IDEAL 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 ten years 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 one year rate of 97.4-98.8%. Stricture, urinary retention, urinary tract infection, recto-urethral fistula, and sepsis are observed at rates of 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively.

Conclusion

The mid-to-long-term real-world data, the safety profiles of cryoablation and HIFU are sound to support and offer as primary treatment for appropriate patients with localized PCa. When compared to other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate-to-long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncologic and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values.

Funding

None

Lead Authors

Srinath Kotamarti, MD
Duke University Medical Center

Co-Authors

Eric S. Adams, MD
Duke University Medical Center

Thomas J. Polascik, MD
Duke University Medical Center

Members of Focal Therapy Society,
Focal Therapy Society