Comparisons of oncological and functional outcomes between primary whole-gland cryoablation and high-intensity focused ultrasound for localized prostate cancer

Abstract

The aim of this study was to conduct a prospective, single-institutional comparison for primary whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in localized prostate cancer with respect to oncological and functional outcomes. From October 2008 to December 2013, a total of 114 and 120 patients with primary whole-gland cryoablation and HIFU for localized prostate cancer, respectively, were enrolled in the study. Prostate-specific antigen (PSA) biochemical recurrence defined by Phoenix definition, salvage treatment-free rate, metastasis-free rate, and PSA biochemical recurrence-free survival analyzed using the Kaplan–Meier method were for oncological outcomes. Functional outcomes included complications and serial International Index of Erectile Function (IIEF)-5 scores, International Prostate Symptom Score (IPSS), and related quality of life (QoL) scores. During the mean follow-up duration of approximately 2 years, the PSA biochemical recurrence rates of the two groups were similar (cryoablation 25.4 %, HIFU 18.3 %). In terms of functional outcomes, patients with HIFU had significantly lower IPSS (5.70 vs. 9.04 at 24 months; p = 0.030), lower erectile dysfunction rate (65.6 vs. 88.0 %; p = 0.015), and higher IIEF-5 score (9.36 vs. 4.18 at 24 months; p = 0.028) than patients with cryoablation. In this study, both primary whole-gland cryoablation and HIFU demonstrated good oncological outcomes for localized prostate cancer. We validated the safety of the two treatment modalities and identified the importance of combined HIFU and transurethral resection of the prostate. The HIFU patients experienced better urinary function improvement and more possible sexual function preservation than the cryoablation patients; therefore, HIFU may provide better quality of life for patients with localized prostate cancer.