Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy

Matthijs J Scheltema, John I Chang, Maret Böhm, Willemien van den Bos, Alexandar Blazevski, Ilan Gielchinsky, Anton M F Kalsbeek, Pim J van Leeuwen, Tuan V Nguyen, Theo M de Reijke, Amila R Siriwardana, James E Thompson, Jean J de la Rosette, Phillip D Stricker, Matthijs J Scheltema, John I Chang, Maret Böhm, Willemien van den Bos, Alexandar Blazevski, Ilan Gielchinsky, Anton M F Kalsbeek, Pim J van Leeuwen, Tuan V Nguyen, Theo M de Reijke, Amila R Siriwardana, James E Thompson, Jean J de la Rosette, Phillip D Stricker

Abstract

Purpose: The design, conduct and completion of randomized trials for curative prostate cancer (PCa) treatments are challenging. To evaluate the effect of robot-assisted radical prostatectomy (RARP) versus focal irreversible electroporation (IRE) on patient-reported quality of life (QoL) and early oncological control using propensity-scored matching.

Methods: Patients with T1c-cT2b significant PCa (high-volume ISUP 1 or any 2/3) who received unifocal IRE were pair-matched to patients who received nerve-sparing RARP. Patient-reported outcomes were prospectively assessed using the Expanded Prostate Cancer Index Composite (EPIC), AUA symptom score and Short Form of Health Survey (SF-12) physical and mental components. Oncological failure was defined as biochemical recurrence (RARP) or positive follow-up biopsies (IRE). Generalized mixed-effect models were used to compare IRE and RARP.

Results: 50 IRE patients were matched to 50 RARP patients by propensity score. IRE was significantly superior to RARP in preserving pad-free continence (UC) and erections sufficient for intercourse (ESI). The absolute differences were 44, 21, 13, 14% for UC and 32, 46, 27, 22% for ESI at 1.5, 3, 6, and 12 months, respectively. The EPIC summary scores showed no statistically significant differences. Urinary symptoms were reduced for IRE and RARP patients at 12 months, although IRE patient initially had more complaints. IRE patients experienced more early oncological failure than RARP patients.

Conclusions: These data demonstrated the superior preservation of UC and ESI with IRE compared to RARP up to 12 months after treatment. Long-term oncological data are warranted to provide ultimate proof for or against focal therapy.

Keywords: Focal therapy; Irreversible electroporation; Prostate cancer; Radical prostatectomy; Robotic.

Conflict of interest statement

Conflict of interest

De la Rosette is paid consultant to AngioDynamics. All other authors have nothing to disclose.

Ethical approval

The board of the Human Research Ethics Committee of St. Vincent’s Hospital (Sydney, Australia) approved prospective acquisition of patient-reported QoL outcomes (HREC approval SVH 13/018) after institutional review. The analysis and data collection were performed following the declaration of Helsinki [28] after written informed consent was obtained from all patients.

Figures

Fig. 1
Fig. 1
a, b Rates of pad-free urinary continence (no need for urinary pads per 24 h), for all men (a) and men who were continent at baseline (b). c, d Rates of erections sufficient for intercourse (erections firm enough to have intercourse), for all men (c) and men who were potent at baseline (d)

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