Partial gland ablation of prostate cancer: Effects of Repeat Treatment.

To evaluate the near-term clinical and pathological effects of repeat partial gland ablation (PGA) in men with intermediate-risk prostate cancer (PCa).

170 men with focal lesions of PCa (all GG2 or GG3) underwent PGA with high-intensity focused ultrasound (HIFU) or cryotherapy (CRYO) in prospective trials. Residual PCa in or near the ablation zone was found in 37 men after a first PGA; 30 went on to receive a second PGA and were the subjects of study. At three timepoints, baseline and six months after first and second ablations, quality-of-life (QOL) questionnaires (IIEF, IPSS) and MRI-guided biopsies (MRGB) were performed. Biopsies were targeted and systematic at baseline and in follow-up, comprehensively about the ablation zone.

All 30 patients completed QOL questionnaires and 26 had MRGB at the three timepoints. Mean QOL scores were not significantly different from baseline after the first or second PGA. No operative complications were encountered; and 'decisional regret' was reported in only 2/29 men after the repeat ablation. A decrease in semen volume was reported by 25% of patients. Repeat ablation was successful (absence of csPCa on MRGB) in 14/26 (53%) of men. PSA levels decreased and MRI lesions resolved after ablations, but neither was a reliable predictor of biopsy outcomes.

When initial PGA fails, repeat PGA is a reasonable consideration, because in near-term follow-up, secondary procedures appear to be safe, causing only minimal detriment to urinary and sexual function, with csPCa becoming undetectable by MRGB in approximately half the patients.

Urology. 2022 Jul 27 [Epub ahead of print]

Nima Nassiri, Shannon Richardson, David Kuppermann, Wayne G Brisbane, Samantha Gonzalez, Lorna Kwan, Ely Felker, Caroline Wallner, Leonard S Marks

Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA. Electronic address: .

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