Partial Gland Ablation of Prostate Cancer: Effects of Repeat Treatment

• Published in: Urology (Ridgewood, N.J.) Vol. 170; pp. 161 - 167
• Main Authors: Nassiri, Nima, Richardson, Shannon, Kuppermann, David, Brisbane, Wayne G., Gonzalez, Samantha, Kwan, Lorna, Felker, Ely, Wallner, Caroline, Marks, Leonard S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022
• Subjects: Humans; Image-Guided Biopsy - methods; Male; Prospective Studies; Prostatic Neoplasms - pathology; Quality of Life
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2022.07.024

To evaluate the near-term clinical and pathological effects of repeat partial gland ablation (PGA) in men with intermediate-risk prostate cancer (PCa). One hundred seventy men with focal lesions of PCa (all GG2 or GG3) underwent PGA with high-intensity focused ultrasound (HIFU) or cryotherapy (CRYO) in prospective trials. Residual PCa in or near the ablation zone was found in 37 men after a first PGA; 30 went on to receive a second PGA and were the subjects of study. At 3 timepoints, baseline and 6 months after first and second ablations, quality-of-life (QOL) questionnaires (IIEF, IPSS) and MRI-guided biopsies (MRGB) were performed. Biopsies were targeted and systematic at baseline and in follow-up, comprehensively about the ablation zone. All 30 patients completed QOL questionnaires and 26 had MRGB at the 3 timepoints. Mean QOL scores were not significantly different from the baseline after the first or second PGA. No operative complications were encountered; and “decisional regret” was reported in only 2/29 men after the repeat ablation. A decrease in semen volume was reported by 25% of patients. Repeat ablation was successful (absence of csPCa on MRGB) in 14/26 (53%) of men. PSA levels decreased and MRI lesions resolved after ablations, but neither was a reliable predictor of biopsy outcomes. When initial PGA fails, repeat PGA is a reasonable consideration, because in near-term follow-up, secondary procedures appear to be safe, causing only minimal detriment to urinary and sexual function, with csPCa becoming undetectable by MRGB in approximately half the patients.