(PD3-4) Comparisons of oncological and functional outcomes among radical retropubic prostatectomy, high dose rate brachytherapy, cryoablation and high-intensity focused ultrasound for localized prostate cancer: a prospective, controlled, nonrandomized tri
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  • 2015-11-30,
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局限性攝護腺癌治療後腫瘤及功能預後比較-攝護腺全切除,放射治療,冷凍治療與海福刀
江博暉、柳易揚、陳柏諺
高雄長庚醫院泌尿科
Comparisons of oncological and functional outcomes among radical retropubic prostatectomy, high dose rate brachytherapy, cryoablation and high-intensity focused ultrasound for localized prostate cancer: a prospective, controlled, nonrandomized trial
Chiang Po Hui, Liu Yi Yang, Chen Po Yen
Kaohsiung Chang Gung Medical Center, Department of Urology
 
Purpose:
To conduct a prospective, controlled, nonrandomized, single institutional comparison for radical retropubic prostatectomy (RRP), high dose rate brachytherapy (HDRBT), cryoablation and high-intensity focused ultrasound (HIFU) in localized prostate cancer with respect to oncological and functional outcomes.
Materials and Methods:
We enrolled 97, 161, 114 and 120 patients of RRP, HDRBT, cryoablation and HIFU respectively for localized prostate cancer from May 2008 to December 2013. PSA biochemical recurrence, salvage treatment-free rate, metastasis-free rate, and PSA biochemical recurrence-free survival were collected for oncological outcomes. Functional outcomes included complications and serial IIEF-5 scores, IPSS and related QoL scores.
Results:
During nearly three years of follow-up, the patients of HDRBT experienced higher PSA biochemical recurrence rate overall (54.7%), as well as D'Amico intermediate-risk (34.4%) and high-risk (61.8%) groups, lower salvage treatment-free rate (46.7%), and metastasis-free rate (90.7%). Besides, the patients of RRP demonstrated higher urethral stricture (29.9%) and urinary incontinence rate (11.3%). The patients of HIFU revealed lower de novo erectile dysfunction rate at one year (65.6%), higher serial IIEF-5 scores, lower IPSS and related QoL scores.
Conclusion:
Among the four treatments, the patients of HDRBT demonstrated the worst oncological outcomes in D'Amico intermediate and high-risk groups. Besides, the patients of RRP had more complications rate in urethral stricture and urinary incontinence. Moreover, the patients of HIFU experienced better urinary function improvement and more possible sexual function preservation. In consideration of trifecta, HIFU may provide equivalent cancer control and better quality of life for patients of localized prostate cancer.
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    2015-11-30 10:46:00
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