A systematic review of outcomes after thermal and nonthermal partial prostate ablation

We sought to compare oncologic and functional outcomes between thermal and nonthermal energy partial gland ablation (PGA) modalities. We conducted comprehensive, structured literature searches, and 39 papers, abstracts, and presentations met the inclusion criteria of pre-PGA magnetic resonance imaging, oncologic outcomes of at least 6 months, and systematic biopsies after PGA. Twenty-six studies used thermal ablation: high-intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation, or radiofrequency ablation. In-field recurrence rates ranged from 0 to 36% for HIFU, 6 to 24% for cryotherapy, 4 to 50% for focal laser ablation, and 20 to 25% for radiofrequency ablation. Twelve studies used nonthermal technologies of focal brachytherapy, vascular-targeted photodynamic therapy, or irreversible electroporation. Focal brachytherapy had the lowest reported failure rate of 8%, vascular-targeted photodynamic therapy had >30% positive in-field biopsies, and irreversible electroporation had in-field recurrence rates of 12-35%. PGA was well tolerated, and nearly all patients returned to baseline urinary function 12 months later. Most modalities caused transient decreases in erectile function. Persistent erectile dysfunction was highest in patients who underwent HIFU. Although oncologic outcomes vary between treatment modalities, systematic review of existing data demonstrates that PGA is a safe treatment option for patients with localized prostate cancer.