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Functional outcomes and safety of focal therapy for prostate cancer: a systematic review on results and patient-reported outcome measures (PROMs)

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Introduction

Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and safety profile than standard whole-gland treatments. Ten different FT modalities have been described in the literature. The objective of our narrative review is to evaluate the safety profile and functional outcomes of these different modalities and the current most used tools of assessment for those outcomes.

Material and methods

Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole-gland treatments were excluded. All articles reporting functional outcomes were included.

Results

One-hundred-seven studies, reporting data on 6933 patients, were included (26 on High Intensity Focal Ultrasound, 22 on Focal Cryotherapy, 14 on Irreversible Electroporation, 11 on Focal brachytherapy, 10 on Focal Laser Ablation, 8 on Photodynamic Therapy, 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation, 1 on Prostatic Artery Embolization, and 7 studies comparing different FTs). Post-operative pad-free rate ranged between 92.3–100%. Greater heterogeneity exists considering the Change in Erectile Function, with Changing in Erectile function- rates ranging between 0–94.4% (Cryotherapy). The most used Patient-Reported Outcome Measures (PROMs) were the International Prostate Symptom Score and the International Index of Erectile Function for incontinence/urinary function and potency, respectively. The most common reported complications were hematuria, infections, and urethral strictures, with rates widely ranging among different treatments. The Clavien–Dindo Classification was the most used (40/88 papers) to describe adverse events.

Conclusion

FT is a promising treatment for localized PCa, achieving excellent results in terms of safety and functional outcomes. There is a wide heterogeneity in the definition of PROMS and time of collection between studies. High quality comparative studies with standard treatments are needed to reinforce these findings.

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The online version contains supplementary material, including the list of all articles retrieved and tables reporting information about these studies.

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Author notes

  1. These authors contributed equally: Rossella Nicoletti, Andrea Alberti.

Authors and Affiliations

  1. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Rossella Nicoletti, Andrea Alberti, Riccardo Campi, Giulio Raffaele Resta, Edoardo Dibilio, Sergio Serni & Mauro Gacci

  2. S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Rossella Nicoletti, Chi Hang Yee, Peter Ka-Fung Chiu, Chi Fai Ng & Jeremy Yuen Chun Teoh

  3. Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy

    Rossella Nicoletti, Andrea Alberti, Riccardo Campi, Giulio Raffaele Resta, Edoardo Dibilio, Sergio Serni & Mauro Gacci

  4. Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy

    Daniele Castellani

  5. Department of Urology, Beijing United Family Hospital and Clinics, 100015, Beijing, China

    Kai Zhang

  6. Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China

    Darren M. C. Poon

  7. Urology Unit, San Giuseppe Hospital, Multimedica Group, Milan, Italy

    Giacomo Maria Pirola

  8. Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy

    Giuseppe Chiacchio, Demetra Fuligni, Carlo Brocca, Carlo Giulioni & Virgilio De Stefano

  9. Ng Teng Fong General Hospital (NUHS), Singapore, Singapore

    Vineet Gauhar

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Contributions

RN and AA were responsible for interpreting data, editing and revise the tables, write the paper. DC, CHY, KZ, DP, PC and RC were responsible for interpreting data, editing summary tables, and editing the manuscript. DC and JYCT were responsible for designing the review protocol, coordinate the group and supervise the project. GRR, ED, GMP, GC, DF, CB, CG and VDS were responsible for collecting and reviewing journal articles, editing summary tables. SS, VG, CFN provided feedback on the manuscript.

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Correspondence to Jeremy Yuen Chun Teoh.

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Nicoletti, R., Alberti, A., Castellani, D. et al. Functional outcomes and safety of focal therapy for prostate cancer: a systematic review on results and patient-reported outcome measures (PROMs). Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00698-8

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