Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy

Abstract

PurposeThe design, conduct and completion of randomized trials for curative prostate cancer (PCa) treatments are challenging. To evaluate the effect of robot-assisted radical prostatectomy (RARP) versus focal irreversible electroporation (IRE) on patient-reported quality of life (QoL) and early oncological control using propensity-scored matching.MethodsPatients with T1c–cT2b significant PCa (high-volume ISUP 1 or any 2/3) who received unifocal IRE were pair-matched to patients who received nerve-sparing RARP. Patient-reported outcomes were prospectively assessed using the Expanded Prostate Cancer Index Composite (EPIC), AUA symptom score and Short Form of Health Survey (SF-12) physical and mental components. Oncological failure was defined as biochemical recurrence (RARP) or positive follow-up biopsies (IRE). Generalized mixed-effect models were used to compare IRE and RARP.Results50 IRE patients were matched to 50 RARP patients by propensity score. IRE was significantly superior to RARP in preserving pad-free continence (UC) and erections sufficient for intercourse (ESI). The absolute differences were 44, 21, 13, 14% for UC and 32, 46, 27, 22% for ESI at 1.5, 3, 6, and 12 months, respectively. The EPIC summary scores showed no statistically significant differences. Urinary symptoms were reduced for IRE and RARP patients at 12 months, although IRE patient initially had more complaints. IRE patients experienced more early oncological failure than RARP patients.ConclusionsThese data demonstrated the superior preservation of UC and ESI with IRE compared to RARP up to 12 months after treatment. Long-term oncological data are warranted to provide ultimate proof for or against focal therapy.Electronic supplementary materialThe online version of this article (10.1007/s00345-018-2281-z) contains supplementary material, which is available to authorized users.

Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study

“…Another group reported on a propensity matched comparison of 50 patients undergoing another type of ablation called irreversible electroporation to 50 radical prostatectomy patients but with only 12 months follow-up. Again, functional outcomes were superior with focal therapy, but failure was significantly higher with 4 patients undergoing salvage therapy whilst none in the radical prostatectomy group experienced biochemical failure at 12months (16). Although not a directly comparable study, Tay et al assessed outcomes from wholegland cryotherapy to focal cryotherapy and showed that using the Phoenix definition for biochemical failure there was no statistically significant difference in the 5-year biochemical disease-free survival rates (76.4% whole-gland vs. 70.0% focal, p=0.26) (17).…”

Visibility of significant prostate cancer on multiparametric magnetic resonance imaging (MRI)—do we still need contrast media?

“…A possible advantage using DCE images may be gained in the assessment of the primary tumor. As the landscape of local therapy for prostate cancer is evolving, and concepts of individualized therapy, such as focal therapy (FT) [ 22 , 23 ], broader application of active surveillance (AS) [ 24 , 25 ], and image-guided radiation, are becoming more prevalent, the need for accurate imaging is also increasing. In these settings, better visibility and improved estimation of tumor location and size are key factors to success.…”

Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project

“…Minimally invasive techniques are used for organ-confined PCa and are a novel strategy for targeted treatment, while preserving healthy tissue and subsequently reduce treatment-related morbidity [4]. Currently, a wide variety of energy sources seem to be capable for FT, i.e., focal laser ablation (FLA) cryosurgery, high intensity-focused ultrasound (HIFU), radiofrequency, microwave, and irreversible electroporation/nanoknife (IRE) [5–7].…”