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

• Published in: World journal of urology Vol. 36; no. 9; pp. 1383 - 1389
• Main Authors: Scheltema, Matthijs J., Chang, John I., Böhm, Maret, van den Bos, Willemien, Blazevski, Alexandar, Gielchinsky, Ilan, Kalsbeek, Anton M. F., van Leeuwen, Pim J., Nguyen, Tuan V., de Reijke, Theo M., Siriwardana, Amila R., Thompson, James E., de la Rosette, Jean J., Stricker, Phillip D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2018; Springer Nature B.V
• Subjects: Aged; Cancer surgery; Clinical trials; Electroporation; Electroporation - methods; Humans; Male; Matched-Pair Analysis; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Organ Sparing Treatments; Original; Original Article; Patient Reported Outcome Measures; Patients; Preservation; Propensity Score; Prospective Studies; Prostate cancer; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - surgery; Quality of Life; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Robots; Statistical analysis; Treatment Outcome; Urological surgery; Urology; Radical prostatectomy; Prostate cancer; Focal therapy; Irreversible electroporation; Robotic
• ISSN: 0724-4983; 1433-8726; 1433-8726
• DOI: 10.1007/s00345-018-2281-z

Purpose The 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. Methods Patients 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. Results 50 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. Conclusions These 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.