TY - JOUR
T1 - Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer
T2 - A Focal Therapy Society Best Practice Statement
AU - Focal Therapy Society
AU - Deivasigamani, Sriram
AU - Kotamarti, Srinath
AU - Rastinehad, Ardeshir R.
AU - Salas, Rafael Sanchez
AU - de la Rosette, J. J.M.C.H.
AU - Lepor, Herbert
AU - Pinto, Peter
AU - Ahmed, Hashim U.
AU - Gill, Inderbir
AU - Klotz, Laurence
AU - Taneja, Samir S.
AU - Emberton, Mark
AU - Lawrentschuk, Nathan
AU - Wysock, James
AU - Feller, John F.
AU - Crouzet, Sebastien
AU - Kumar M., Praveen
AU - Seguier, Denis
AU - Adams, Eric S.
AU - Michael, Zoe
AU - Abreu, Andre
AU - Jack Tay, Kae
AU - Ward, John F.
AU - Shinohara, Katsuto
AU - Katz, Aaron E.
AU - Villers, Arnauld
AU - Chin, Joseph L.
AU - Stricker, Phillip D.
AU - Baco, Eduard
AU - Macek, Petr
AU - Ahmad, Ardalan E.
AU - Chiu, Peter K.F.
AU - Crawford, E. David
AU - Rogers, Craig G.
AU - Futterer, Jurgen J.
AU - Rais-Bahrami, Soroush
AU - Robertson, Cary N.
AU - Hadaschik, Boris
AU - Marra, Giancarlo
AU - Valerio, Massimo
AU - Chong, Kian Tai
AU - Kasivisvanathan, Veeru
AU - Tan, Wei Phin
AU - Lomas, Derek
AU - Walz, Jochen
AU - Guimaraes, Gustavo Cardoso
AU - Mertziotis, Nikos I.
AU - Becher, Ezequiel
AU - Finelli, Antonio
AU - Kasraeian, Ali
N1 - Publisher Copyright:
© 2023
PY - 2023/12
Y1 - 2023/12
N2 - Context: 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. Objective: 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. Evidence acquisition: 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. Evidence synthesis: 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. Conclusions: 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 oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. Patient summary: Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
AB - Context: 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. Objective: 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. Evidence acquisition: 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. Evidence synthesis: 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. Conclusions: 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 oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. Patient summary: Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
KW - Ablation therapy
KW - Best practice statement
KW - Cryotherapy
KW - Focal Therapy Society
KW - Functional outcomes
KW - High-intensity focused ultrasound
KW - Oncological outcomes
KW - Prostate cancer
KW - Whole-gland ablation
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U2 - 10.1016/j.eururo.2023.06.013
DO - 10.1016/j.eururo.2023.06.013
M3 - Review article
C2 - 37419773
AN - SCOPUS:85164436404
SN - 0302-2838
VL - 84
SP - 547
EP - 560
JO - European Urology
JF - European Urology
IS - 6
ER -