Introduction: Repeat focal therapy (FT) may be a viable treatment option in appropriately selected men who fail initial cryoablation or high-intensity focused ultrasound (HIFU). Herein, we sought to determine complications, functional outcomes, and short-term oncological outcomes after repeat FT for localized prostate cancer (CaP).
Methods: Subjects were all men with localized CaP diagnosed by MRI/US fusion biopsy who underwent cryoablation or HIFU, complicated by treatment failure (Grade Group 2 or greater CaP on follow-up biopsy, or detectable disease recurrence). The primary endpoint was peri-operative, 30, and 90 day complications. Secondary endpoints were month continence and erectile function, and oncological outcomes up to one year.
Results: 23.5% (43/183) required repeat FT after initial cryoablation or HIFU (Table 1). There were zero class III or higher Clavien-Dindo complications after repeat FT at any timepoint. All men were continent. There were zero reports of worsening urinary symptoms by Internationalized Prostate Symptom Score (IPSS), and urinary bother improved by an average of 0.33 points (S.D. 0.87). Of men who remained sexually active, erectile function by the International Index of Erectile Function (IIEF-5) declined by an average of 1.17 points (S.D. 4.2). 28 men have at least 6 months of follow up after retreatment, of which 12 (43%) had persistent disease.
Conclusions: Repeat FT for treatment failure after initial cryoablation of HIFU yields excellent adverse event and functional outcome profiles. Longer follow up is needed to evaluate oncological efficacy.
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