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

Bakavičius, Arnas; Sánchez-Salas, Rafael; Muttin, Fabio; Sivaraman, Arjun; Dell’Oglio, Paolo; Barret, Éric; Rozet, François; Mombet, Annick; Prapotnich, Dominique; Cathala, Nathalie; Cathelineau, Xavier

doi:10.1089/end.2018.0809

Cited by 18 publications

(27 citation statements)

References 21 publications

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“…As the urethra is the only organ structure assuring passage within the prostate, a damaged urothelium becomes susceptible for obstructions or ascending infections. A recent publication investigated the incidence, severity and timing of onset of complications after HIFU treatment in patients with PCa 18 . However, to the best of our knowledge, we are the first group to present a descriptive association between specific ablation zones and their complication rates.…”

Section: Discussionmentioning

confidence: 99%

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Schmid

Schindele

Mortezavi

et al. 2020

Urologic Oncology: Seminars and Original Investigations

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Purpose To investigate focal therapy using High Intensity Focused Ultrasound (HIFU) for the treatment of localized prostate cancer (CaP), we analyzed the safety and complications of this procedure. Methods Patients (pts) eligible for this multicenter prospective cohort study suffered from low to intermediate risk localized CaP with no prior treatment. After tumor identification on multiparametric MRI and in prostate biopsy, the lesions were treated with HIFU observing a safety margin of 8 to 10 mm. Adverse events (AE) after 30 and 90 days, as well as the required interventions were assessed and stratified for treatment localizations. Results Of the 98 men included in the study in two European centers, 35 (35.7%) experienced AEs in the first 30 days after HIFU intervention with Clavien-Dindo grade II: 15 pts (15.3%) had a postoperative urinary tract infection and 26 pts (26.5%) a urinary retention. Four pts (4.1%) underwent subsequent intervention (Clavien-Dindo grade IIIa/b). The number of late postoperative complications occurring between 30 and 90 days after intervention was low (2.0%). The highest complication rate was associated with tumors located at the anterior base (50.0%). The inclusion of the urethra in the ablation zone led to AEs in 20 out of 41 cases (48.8%) and represented a significant risk factor for complications within 30 days (odds ratio = 2.53; 95% confidence interval: 1.08-5.96; P = 0.033). Conclusions Focal therapy of CaP lesions with a robotic HIFU-probe is safe and renders an acceptable rate of minor early AEs. The inclusion of the urethra in the ablation zone leads to an increase in early complications and should be avoided whenever possible.

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Section: Discussionmentioning

confidence: 99%

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Schmid

Schindele

Mortezavi

et al. 2020

Urologic Oncology: Seminars and Original Investigations

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show abstract

“…The search protocol yielded 13 studies that were identified for inclusion after thorough assessment (Figure 1) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Eight studies were single center series, while three were multicenter cohorts and two were derived from the Cryo On-Line Data (COLD) multi-center registry.…”

Section: Resultsmentioning

confidence: 99%

“…Nonetheless, reviewed studies providing oncologic results did highlight a 2% cumulative rate of patients developing metastases. While the overall review cohort featured mean/median follow- The current review features studies with highly-varied approaches to biopsy strategy for patient selection, including only three cohorts incorporating 3-D template mapping biopsies and one utilizing a confirmatory systematic biopsy (19,20,23,24). Indeed, such a heterogeneous approach is also evidenced in the literature, including usage of conventional systematic biopsy, saturation biopsy, fusion targeted biopsy, and 3-D template mapping biopsy.…”

Section: Discussionmentioning

confidence: 99%

Focal cryotherapy for prostate cancer: a contemporary literature review

Kotamarti¹,

Polascik²

2023

Ann Transl Med

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Objective: To perform a comprehensive review of the contemporary literature regarding both functional and oncologic outcomes after primary focal cryotherapy for prostate cancer (PCa), providing these results as a foundation for discussing recent developments in the realm of focal therapy. Background: Traditional treatments for PCa are often associated with debilitating functional side effects for patients. Due to advances in imaging and biopsy strategies, focal ablative therapies recently have garnered much interest and offer an alternative primary treatment for PCa patients with localized disease. Focal cryoablation utilizes heat extraction from tissues to generate an iceball and cause tissue destruction while sparing uninvolved prostatic regions. Optimized patient selection and postoperative management continue to be areas of interest and study as the field continues to develop. Methods: A search was performed of the PubMed and Embase databases to identify articles pertaining to primary focal PCa cryoablation since our group's last comprehensive review in 2016. Conclusions: Primary focal cryoablation for PCa offers optimized functional outcomes and a favorable adverse event profile. True evaluation of oncologic outcomes is hampered by lack of long-term follow-up and highly variable clinical endpoints across these studies. Nonetheless, outcomes appear adequate in the shortto medium-term time frame. Utilization of focal cryoablation is expected to grow with continued refinement of patient selection and management options in cases of treatment failure.

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“…Patients should also be warned about possible urethral sloughing following focal therapy. The frequency and amount of debris may vary between the energy sources and the ablation template ( 31 ). In some instances, urethral sloughing and debris might block the catheter causing acute urinary retention.…”

Section: Resultsmentioning

confidence: 99%

Focal Therapy for Prostate Cancer: Complications and Their Treatment

et al. 2021

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Focal therapy is a modern alternative to selectively treat a specific part of the prostate harboring clinically significant disease while preserving the rest of the gland. The aim of this therapeutic approach is to retain the oncological benefit of active treatment and to minimize the side-effects of common radical treatments. The oncological effectiveness of focal therapy is yet to be proven in long-term robust trials. In contrast, the toxicity profile is well-established in randomized controlled trials and multiple robust prospective cohort studies. This narrative review summarizes the relevant evidence on complications and their management after focal therapy. When compared to whole gland treatments, focal therapy provides a substantial benefit in terms of adverse events reduction and preservation of genito-urinary function. The most common complications occur in the peri-operative period. Urinary tract infection and acute urinary retention can occur in up to 17% of patients, while dysuria and haematuria are more common. Urinary incontinence following focal therapy is very rare (0–5%), and the vast majority of patients recover in few weeks. Erectile dysfunction can occur after focal therapy in 0–46%: the baseline function and the ablation template are the most important factors predicting post-operative erectile dysfunction. Focal therapy in the salvage setting after external beam radiotherapy has a significantly higher rate of complications. Up to one man in 10 will present a severe complication.

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

Cited by 18 publications

References 21 publications

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications

Focal cryotherapy for prostate cancer: a contemporary literature review

Focal Therapy for Prostate Cancer: Complications and Their Treatment

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