The design, conduct and completion of randomized trials for curative prostate cancer (PCa) treatments are challenging. To evaluate the effect of robot-assisted radical prostatectomy (RARP) versus focal irreversible electroporation (IRE) on patient-reported quality of life (QoL) and early oncological control using propensity-scored matching.
Patients with T1c-cT2b significant PCa (high-volume ISUP 1 or any 2/3) who received unifocal IRE were pair-matched to patients who received nerve-sparing RARP. Patient-reported outcomes were prospectively assessed using the Expanded Prostate Cancer Index Composite (EPIC), AUA symptom score and Short Form of Health Survey (SF-12) physical and mental components. Oncological failure was defined as biochemical recurrence (RARP) or positive follow-up biopsies (IRE). Generalized mixed-effect models were used to compare IRE and RARP.
50 IRE patients were matched to 50 RARP patients by propensity score. IRE was significantly superior to RARP in preserving pad-free continence (UC) and erections sufficient for intercourse (ESI). The absolute differences were 44, 21, 13, 14% for UC and 32, 46, 27, 22% for ESI at 1.5, 3, 6, and 12 months, respectively. The EPIC summary scores showed no statistically significant differences. Urinary symptoms were reduced for IRE and RARP patients at 12 months, although IRE patient initially had more complaints. IRE patients experienced more early oncological failure than RARP patients.
These data demonstrated the superior preservation of UC and ESI with IRE compared to RARP up to 12 months after treatment. Long-term oncological data are warranted to provide ultimate proof for or against focal therapy.
World journal of urology. 2018 Mar 28 [Epub ahead of print]
Matthijs J Scheltema, John I Chang, Maret Böhm, Willemien van den Bos, Alexandar Blazevski, Ilan Gielchinsky, Anton M F Kalsbeek, Pim J van Leeuwen, Tuan V Nguyen, Theo M de Reijke, Amila R Siriwardana, James E Thompson, Jean J de la Rosette, Phillip D Stricker
Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia. ., Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia., Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands., Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands., St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia.