Although still experimental, focal treatment is being increasingly implemented in the management of prostate cancer (PCa). Aim of the current study was to compare functional and oncologic outcomes of High Intensity Focal Ultrasound (HIFU) hemiablation of the prostate to robotic-assisted laparoscopic prostatectomy (RALP) in the management of unilateral PCa. 55 men with unilateral, clinically localized PCa underwent HIFU hemiablation of the affected prostatic lobe between 2007 and 2015. All patients were diagnosed with unilateral disease on the basis on full concordance between multiparametric MRI and MRI-guided biopsies. These patients were matched 1:1 with patients who underwent RALP for PCa in which pT2a-b disease (unilateral) was found on final pathologic analysis. Matching criteria were Gleason score, PSA and cT stage. Treatment failure was defined as the need for salvage external beam radiotherapy or systemic androgen deprivation therapy due to disease progression. Kaplan Meier curves and log-rank tests were constructed to assess differences in salvage treatment free survival across surgical techniques. Matching was successful with no significant differences across the two groups. HIFU was associated to better and faster recovery of continence, with most men (82%) showing no signs of urinary incontinence even right after surgery. The risk of erectile dysfunction was significantly lower after focal HIFU. No significant difference was found in salvage treatment across the two surgical approaches: 7/55 men in the HIFU vs 6/55 in the RALP group (p=0.76). Nonetheless, 7 more patients in the HIFU arm required complementary treatment on the contralateral lobe after developping a contralateral PCa. In this matched pair analysis, HIFU hemiablation was comparable to RALP in controlling localized, unilateral PCa, with no significant differences in the need for salvage therapies. HIFU was also associated to significantly better functional outcomes. Accurate patient selection remains vital and larger prospective trials are needed to confirm our findings.
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Journal of endourology. 2016 Oct 31 [Epub ahead of print]
Simone Albisinni, Fouad Aoun, Simon Bellucci, Ibrahim Biaou, Ksenija Limani, Eric Hawaux, Alexandre Peltier, Roland van Velthoven
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