Partial gland ablation versus radical prostatectomy Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low- and Intermediate-risk Prostate Cancer: Oncologic and Functional Outcomes

To analyze oncologic and functional outcomes of partial gland ablation (PGA) compared with robot-assisted radical prostatectomy (RARP) for patients with low-and intermediate-risk prostate cancer.

From July 2009 to September 2015, 1883 patients underwent RARP and 373 had PGA. From those, we selected 1458 participants (1222 RARP and 236 PGA) who have Gleason score 3+3 or 3+4, clinical stage ≤T2b, prostate-specific antigen(PSA) ≤15ng/dl, unilateral disease and life expectancy >10 years. Propensity score matching analysis 1:2 was applied on the overall RARP sample selecting 472 patients for between comparison. As PGA, 188 men underwent high-intensity focused ultrasound (HIFU) and 48 had cryotherapy. Oncologic outcomes were analyzed in terms of the need for salvage treatment. PGA failure was defined as any positive control biopsy after treatment. Functional outcomes were assessed with validated questionnaires.

Matching was successful across the two groups, althought men treated with PGA were older (p <0.001). Mean follow-up in PGA group was 38.44 months. PGA failure was observed in 68 (28.8%) patients, 53 (28.1%) with HIFU and 15(31.2%) with cryotherapy. PGA was associated with higher risk of salvage treatments (HR 6.06; p <0.001) and complications were comparables between groups (p=0.06). RARP was associated with less continence recovery and lower potency rates at 3, 6, and 12 mo after surgery (p <0.001).

For selected patients with organ-confined prostate cancer, PGA offered good oncological control with fewer adverse effects requiring more additional treatments. Potency and continence appear to be better preserved with PGA.

The Journal of urology. 2017 Aug 17 [Epub ahead of print]

Silvia Garcia-Barreras, Rafael Sanchez-Salas, Arjun Sivaraman, Eric Barret, Fernando Secin, Igor Nunes-Silva, Estefania Linares-Espinós, François Rozet, Marc Galiano, Xavier Cathelineau

Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France. Electronic address: ., Memorial Sloan Kettering Cancer Center, New York, USA., CEMIC University Hospital, Buenos Aires, Argentina., Hospital Universitario La Paz, Madrid, Spain.