Predicting 1-Year Trifecta Outcomes After High-Intensity Focused Ultrasound and Cryoablation for Low- and...

Area of Science:

• Urology
• Oncology
• Medical Technology

Background:

• Focal therapy (FT) is gaining traction for localized prostate cancer (PCa), balancing cancer control with functional preservation.
• Prostate gland cryoablation (PGC) and high-intensity focused ultrasound (HIFU) are leading FT energy sources.
• Comparative data and standardized endpoints for these techniques are limited.

Purpose of the Study:

• To prospectively compare oncologic and functional outcomes of HIFU versus PGC in localized PCa patients at 1-year follow-up.
• To identify predictors of trifecta achievement: no treatment failure, urinary continence, and erectile function recovery.

Main Methods:

• A prospective, single-center study of 163 patients with localized PCa treated with HIFU (n=49) or PGC (n=114) from 2019-2024.
• Comparison of baseline, perioperative, oncologic, and functional outcomes at 1-year.
• Multivariable analysis to determine predictors of trifecta achievement.

Main Results:

• HIFU had shorter operative times but longer catheterization than PGC.
• PGC had a higher overall complication rate (mostly Grade I-II).
• One-year treatment failure rates were similar (8.1% HIFU vs. 8.7% PGC).
• Functional outcomes (continence, potency) and trifecta rates (38.9% HIFU vs. 37.4% PGC) were comparable.
• Hypertension, lower PSA, better baseline erectile function, and unilateral ablation predicted trifecta achievement.

Conclusions:

• HIFU and PGC demonstrate similar trifecta achievement rates and functional recovery at 1 year for localized PCa.
• Both focal therapy modalities are functionally safe and oncologically feasible in selected patients.
• Standardized composite endpoints are valuable but require further refinement for focal therapy evaluation.