Comprehensive Evaluation of Focal Therapy Complications in Prostate Cancer: A Standardised Methodology.

Today, up to one-third of newly diagnosed prostate cancer (PCa) cases may be suitable for focal treatment. The lack of data about the toxicity profiles of lesion-targeting therapies, however, have made it difficult to compare treatment modalities. The aim of the present study was to evaluate comprehensively the incidence, severity, and timing of onset of complications for PCa patients undergoing focal high-intensity focused ultrasound (HIFU) and focal cryosurgical ablation of the prostate (CSAP).

336 patients were included who underwent focal HIFU or focal CSAP as a primary treatment for PCa between January 2009 and December 2017. Mean follow-up was 11 mo (SD: 3.0). All complications were captured and graded according to severity, and classified by timing of onset. Univariate and multivariate analysis was performed to identify predictors of the most common side-effects.

There were 98 complications in 79/210 patients (38%) undergoing focal HIFU and 34 complications in 27/126 patients (21%) undergoing focal CSAP. In terms of severity, 95% of the complications of focal HIFU and 91% of focal CSAP were minor. Most complications presented in the early postoperative period. On multivariate analysis, sub-total HIFU was associated with acute urinary retention (AUR), while smaller prostate size and longer catheterisation time with dysuria. In CSAP patients, longer catheterisation time was associated with AUR and urethral sloughing. The main limitation is non-randomized and retrospective nature.

Focal HIFU and focal CSAP provides a tolerable toxicity, with primarily minor complications presenting in the early postoperative period.

Journal of endourology. 2019 Apr 24 [Epub ahead of print]

Arnas Bakavicius, Rafael Sanchez-Salas, Fabio Muttin, Arjun Sivaraman, Paolo Dell'Oglio, Eric Barret, Francois Rozet, Annick Mombet, Dominique Prapotnich, Nathalie Cathala, Xavier Cathelineau

Institut Mutualiste Montsouris, 26953, Department of Urology, Paris, France., Institut Mutualiste Montsouris, 26953, Department of Urology, Paris, France ; ., Memorial Sloan Kettering Cancer Center, Urology Service, Department of Surgery, New York, United States ; ., Institut Mutualiste Montsouris, Department of Urology, Paris, France ; ., Institut Mutualiste Montsouris, Department of Urology, Paris, France ; ., Institut Mutualiste Montsouris, 26953, Department of Urology, Paris, France ; ., Institut Mutualiste Montsouris, Department of Urology, Paris, France ; ., Institut Mutualiste Montsouris, 26953, Department of Urology, Paris, France ; ., Institut Mutualiste Montsouris, 26953, Department of Urology, Paris, France ; .