Presentation Authors: Jonathan Fainberg*, Stamford, CT, Bashir Al Hussein Al Awamleh, Antonio Primo de Rosa, Gregory Chesnut, Taehyoung Lee, Behfar Ehdaie, New York, NY
Introduction: We seek to compare thermal versus non-thermal energy modalities for partial gland ablation (PGA) in a contemporary cohort of patients using MRI-targeted biopsy for patient selection.
Methods: Systematic literature searches were conducted in MEDLINE, Embase and the Cochrane Library. A total of 3401 abstracts were screened, of which 201 full texts were reviewed. 162 studies were excluded. 39 papers, abstracts and presentations met the inclusion criteria. Studies included pre-procedure MRI with targeted partial gland therapy, at least 6-month oncologic outcomes, and systematic post-therapy biopsies.
Results: 27 studies utilized thermal ablative technologies, which included high intensity focused ultrasound (HIFU), cryotherapy (cryo), focal laser ablation (FLA) and radiofrequency ablation (RFA). Thermal PGA in-field recurrence rates varied widely across these technologies: while one small HIFU study reported 0% failure rate in 25 patients, other larger studies had recurrence rates as high as 36%. FLA failures ranged from 4-50% however the larger studies reported rates of 23-27%. Similarly, cryo failures ranged from 6-24% and 2 RFA studies had failure rates of 20 and 25%. _x000D_
12 studies utilized non-thermal technologies, which included focal brachytherapy, vascular-targeted photodynamic therapy (VTP) and irreversible electroporation (IRE). Non-thermal PGA in-field failure rates ranged from 8-35%. Focal brachytherapy reported the lowest failure rate of 8% among 318 patients treated with Gleason 30% positive in-field post-procedure biopsies rate among 147 patients. IRE studies were smaller, reporting in-field recurrence rates of 12-35% among 20-65 patients. _x000D_
In all 39 studies the procedures were well tolerated. Nearly all patients recovered to baseline urinary function at 12 months post-procedure. Most energy modalities reported transient decrease in erectile function however, 14-22% of 900 patients from 3 large HIFU studies reported persistent erectile dysfunction (ED) after 12+ months.
Conclusions: Systematic review of the existing data shows that PGA is safe; however, there is tremendous variability in oncologic outcomes among the different treatment modalities. Long-term erectile function appears worse in the HIFU group.