Mp52-20 an Updated Review of Prostate Cancer Focal Therapy Oncological, Functional, and Urinary Outcomes

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (MP52)1 May 2024MP52-20 AN UPDATED REVIEW OF PROSTATE CANCER FOCAL THERAPY ONCOLOGICAL, FUNCTIONAL, AND URINARY OUTCOMES Orry Matthew Marciano, David Jung, Manish Pathuri, Ifeoma Ikedionwu, and Omer Raheem Orry Matthew MarcianoOrry Matthew Marciano , David JungDavid Jung , Manish PathuriManish Pathuri , Ifeoma IkedionwuIfeoma Ikedionwu , and Omer RaheemOmer Raheem View All Author Informationhttps://doi.org/10.1097/01.JU.0001008864.84854.b7.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is a leading cause of death for men in the United States. Focal therapy is currently being studied as an alternative to traditional modalities in early-stage treatment where only part of the prostate is treated. Focal therapy is becoming an appealing treatment option for patients with prostate cancer because of the apparent less severe side effects as compared to surgery or radiation therapy, which have high rates of erectile dysfunction and urinary incontinence. However, since focal therapy in prostate cases is a relatively new treatment modality, prospective and retrospective evaluation of patient outcomes is necessary and ongoing. METHODS: Web search was performed on the PubMed database. The search was limited to articles published in the English language and reporting focal therapy outcomes between 2019 and 2023, including randomized controlled trials, prospective development studies, prospective and retrospective case series. The following data were extracted from each study: year, type of focal therapy, design, participants, demographic, IIEF values, ED proportion, IPSS, EPIC, urinary tract infection proportions, pad incontinence proportion, fistula rate, urinary retention rate, hematuria, Gleason scores, time to oncologic follow-up, recurrence, and presence of cancer after treatment. RESULTS: Twenty three studies, consisting of cryotherapy, IRE ablation, HIFU, TULSA, focal ablation, and microwave ablation, met the inclusion criteria and were reviewed. Reviews of focal microwave ablation were absent in the current literature and this could be one of the first reviews to incorporate them. Oncologic outcomes were reported in 17 of 23 studies included in this review. Median follow-up ranged from 3 to 42 months.The main oncologic outcomes analyzed were in-field/out-of-field recurrence and presence of prostate cancer after the procedure. The two largest HIFU studies (n=90, n=101) had 9% and 24% respectively in presence of clinically significant recurrence. The two focal microwave ablation studies (n=55, n=5) had 9% and 20% recurrence rates respectively. In terms of functional outcomes, IPSS and IIEF increased in most studies. Lastly, complication rates among all studies were generally low. 9 studies reported UTI rates ranging from 0% (n=6, n=41) to 30% (n=10) in a TULSA prospective study. Urinary retention rates were reported in 14 studies, with a range from 0% (n=41) to 30% (n=10). CONCLUSIONS: The review of literature suggests that focal therapy is a safe and effective option for low to medium grade prostate cancer and supports the safe and continued use of HIFU, TULSA and IRE ablation. Focal microwave ablation seems to be a promising alternative but more trials are necessary to test its efficacy. One limitation of the studies reviewed is that IPSS and IIEF increases were common in 6 month follow-up. It has been suggested that these values could improve overtime. Further data is required to evaluate the long-term oncologic and functional outcomes and complications for these therapies and any impact they may have on treatment decisions. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e861 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Orry Matthew Marciano More articles by this author David Jung More articles by this author Manish Pathuri More articles by this author Ifeoma Ikedionwu More articles by this author Omer Raheem More articles by this author Expand All Advertisement PDF downloadLoading ...