Objective
To evaluate the near-term clinical and pathological effects of repeat partial gland
ablation (PGA) in men with intermediate-risk prostate cancer (PCa).
Materials and methods
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.
Results
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.
Conclusion
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.
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Article Info
Publication History
Published online: July 27, 2022
Accepted:
July 17,
2022
Received:
March 16,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
