High Intensity Focused Ultrasound Ablation for Prostate Cancer: Whole Versus Partial Gland Ablation.

Abstract

We compared the clinical outcomes between whole-gland ablation (WGA) and partial gland ablation (PGA) using the high-intensity focused ultrasound (HIFU) technique for localized prostate cancer (PCa). We retrospectively investigated 206 patients who underwent WGA or PGA for localized PCa. Follow-up prostatic biopsy was performed 1 year postoperatively. We performed intergroup comparison of the postoperative functional and oncological outcomes and complication rates. In this study, 152 and 54 patients underwent PGA and WGA, respectively. The total operation time was significantly longer in the WGA than in the PGA group (107.5 minutes vs. 95.0 minutes, P=.004). Of the 86 patients who underwent postoperative prostate biopsy, no residual cancer was detected in 70.4% of the WGA and 72.9% of the PGA group. Incontinence-free survival was significantly shorter in the PGA than in the WGA group (P= .047); however, no significant intergroup difference was observed in erectile dysfunction-free survival (P= .317). The postoperative adverse event rate was significantly lower in the PGA than in the WGA group (37.5% vs. 66.7%, P=.023). Of the total patients investigated, 43 (20.9%) required additional endoscopic surgery for bladder outlet obstruction, and the additional endoscopic surgery rate was significantly higher in the WGA than in the PGA group (35.2% vs. 15.8%, P=.005). HIFU treatment was associated with acceptable oncological and fair functional outcomes in patients with localized PCa. Moreover, PGA was associated with significantly better clinical outcomes, including the faster recovery of urinary incontinence and adverse effects.