Biopsy and Erectile Functional Outcomes of Partial Prostate Ablation: A Systematic Review and Meta-Analysis of Prospective Studies.

To provide a systematic summary of prospectively performed studies evaluating ablative therapies for the treatment of prostate cancer (PCa) that included protocol-mandated assessment of (1) residual disease by post-treatment biopsy and/or (2) erectile functional outcomes.

We performed a comprehensive literature search in September 2022. Studies were evaluated according to a pre-defined and registered plan in PROSPERO (CRD42022302777). Only prospective trials with protocol-mandated post-treatment prostate biopsies or functional assessments were included. Targeted focal therapy was the only ablation pattern with sufficient data to perform meta-analyses (29 studies, 1079 patients).

At baseline, 65.0% of patients treated with targeted focal therapy harbored grade group (GG) ≥2 PCa. One year after treatment, in-field treatment failure with ≥GG1 and ≥GG2 PCa occurred in 25.7% (range 11.1-66.7%) and 8.8% (range 0-27.8%) of men, respectively. In patients that received whole-gland biopsies one year after ablation, residual ≥GG1 and ≥GG2 PCa was detected anywhere in the prostate in 43.7% (range 19.4-71.7%) and 13.0% (range 0-35.9%) of men. Erectile function was negatively affected by treatment, but 78.7% were potent one year after targeted focal therapy (7 studies, 197 patients), and the average decrease in erectile function scores was 8.8% at one year (21 studies, 760 patients).

Though long-term data after targeted focal therapy are limited, oncologic and treatment failure occurred in 13% and 9% (≥GG2 at 6-12 months after treatment). Most men were able to maintain potency. This work can help benchmark new techniques and power future trials.

Urology. 2023 Sep 27 [Epub ahead of print]

Dallin Busby, Jordan M Rich, Ralph Grauer, Basil Kaufmann, Krunal Pandav, Akshay Sood, Ashutosh K Tewari, Mani Menon, Hiten D Patel, Michael A Gorin

Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA. Electronic address: ., Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; Department of Urology, University Hospital of Zurich, Zurich, Switzerland., Department of Biomedical Engineering, Emory University, Atlanta, GA, USA., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.