Partial gland ablation versus prostate surgery in men with low- or intermediate-risk prostate cancer

The authors aimed to determine patient outcomes following partial gland ablation compared to robot-assisted radical prostate surgery in men with low- and intermediate- risk prostate cancer.

The authors concluded that men with cancer confined to the prostate benefited from partial gland ablation, as it was more successful with fewer side effects compared to robot-assisted radical prostate surgery.

Prostate surgery is the surgical removal of the prostate gland. Following this procedure, patients may experience urinary incontinence, erectile dysfunction and a general decline in sexual function. Robot-assisted radical prostatectomy (RARP) is a relatively new procedure used to surgically remove the prostate gland. This involves small inciscions using robotic assistance to remove the prostate, seminal vesicles (tube-like glands which make semen) and occasionally lymph nodes. Partial gland ablation (PGA) is another treatment that targets cancer cells in the prostate gland, with similar benefits to radical options. One type of PGA is high-intensity focused ultrasound (HIFU – kills cancer cells using high frequency sounds waves). Another type of PGA is cryoablation (using extremely cold conditions administered through a thin, wand-like needle to kill cancer cells).

These treatments can be used in men with low- and intermediate-risk prostate cancer. Further studies are needed to determine the benefits of PGA compared to RARP in men with low- and intermediate-risk prostate cancer.

The aim of this study was to determine patient outcomes following PGA compared to RARP in men with low- and intermediate- risk prostate cancer.

1,458 men participated in this study. 1,222 men in group 1 received RARP and 236 men in group 2 received PGA. 188 men in group 2 received HIFU and 48 men received cryoablation. The average follow-up was in group 2 was 38.44 months.

Severe complications were more common in group 1 than in group 2. The most common were bleeding or abnormal blood flow complications, urinary infections and bowel problems. The most common in group 2 were urinary retention and infections. Time to reach PSA nadir (levels indicating treatment success and cancer cure) was lower in group 1 than group 2.

PGA failure was observed in 28.8% of patients, 28.1% who received HIFU and 31.2% who received cryoablation. PGA was also associated with a higher risk of salvage treatments and complications. The most common salvage treatments were brachytherapy (10%), cryoablation (4%), HIFU (28%), RARP (16%), external beam radiation therapy (16% [EBRT – delivering radiation beams at the tumor site from outside the body]), hormone therapy and EBRT (24%).

In group 2, men who experienced biochemical recurrence (increase in PSA levels after treatment) were treated with EBRT (80%), hormone therapy plus EBRT (10%), and hormone therapy (10%). RARP was associated with less continence recovery after treatment and lower potency rate at 3, 6 and 12 months after surgery. 

The authors concluded that men with organ-confined prostate cancer benefited from partial gland ablation with fewer side effects and improved overall potency and continence compared to robot-assisted radical prostate surgery.