Established focal therapy-hifu, ire, or cryotherapy-where are we now?-a systematic review and meta-analysis

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dc.contributor.authorTay, Kae Jack
dc.contributor.authorFong, Khi Yung
dc.contributor.authorStabile, Armando
dc.contributor.authorDominguez Escrig, Jose Luis
dc.contributor.authorUkimura, Osamu
dc.contributor.authorRodriguez Sanchez, Lara
dc.contributor.authordel Pilar Laguna Pes, Maria
dc.date.accessioned2025-10-17T12:05:51Z
dc.date.available2025-10-17T12:05:51Z
dc.date.issued2025
dc.departmentİstanbul Medipol Üniversitesi, Uluslararası Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Üroloji Ana Bilim Dalı
dc.description.abstractIntroduction: Focal Therapy (FT) is a treatment option for the treatment of limited volume clinically significant prostate cancer (csPCa). We aim to systematically review outcomes of established FT modalities to assess the contemporary baseline and identify gaps in evidence that will aid in further trial and study design. Methods: We conducted a systematic review and meta-analysis of all primary studies reporting outcomes of FT using cryotherapy, high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE). We described patient inclusion criteria, selection tools, treatment parameters, and surveillance protocols, and pooled overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), biochemical progression (BP), biopsy, secondary treatment, sexual, and urinary function outcomes. Composite failure was defined as salvage whole gland ablation, radical treatment, hormonal therapy or transition to watchful waiting. Synthesis: We identified 49 unique cohorts of men undergoing FT between 2008 and 2024 (21 cryotherapy, 20 HIFU, and 8 IRE). Median follow-up ranged from 6 to 63 months. Pooled OS was 98.0%, CSS 99.3%, and MFS 98.5%. Pooled BP was 9.4%/year. Biopsy was mandated post-FT within 24 months in 36/49 (73.5%) cohorts, with pooled csPCa (GG ≥ 2) rates of 22.2% overall, 8.9% infield, and 12.3% outfield. The pooled rate of secondary FT was 5.0%, radical treatment 10.5%, and composite failure 14.1%. Of 35 studies reporting sexual function, 45.7% reported a low, 48.6% moderate, and 5.7% severe impact. For 34 cohorts reporting urinary function, 97.1% reported a low impact. No differences were noted between cryotherapy, HIFU, or IRE in any of the outcomes. Conclusion: FT with cryotherapy, HIFU, and IRE is associated with good short-intermediate term oncological and functional outcomes. However, outcome reporting is heterogeneous and often incomplete. Long-term follow-up and standardized reporting are required to better define and report FT outcomes.
dc.description.sponsorshipNational Medical Research Council, Singapore
dc.identifier.citationTay, K. J., Fong, K. Y., Stabile, A., Dominguez Escrig, J. L., Ukimura, O., Rodriguez Sanchez, L. ... del Pilar Laguna Pes, M. (2025). Established focal therapy-hifu, ire, or cryotherapy-where are we now?-a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, 28(3), 693-706. http://dx.doi.org/10.1038/s41391-024-00911-2
dc.identifier.doi10.1038/s41391-024-00911-2
dc.identifier.endpage706
dc.identifier.issn1365-7852
dc.identifier.issn1476-5608
dc.identifier.issue3
dc.identifier.pmid39468217
dc.identifier.scopus2-s2.0-85207806838
dc.identifier.scopusqualityQ1
dc.identifier.startpage693
dc.identifier.urihttp://dx.doi.org/10.1038/s41391-024-00911-2
dc.identifier.urihttps://hdl.handle.net/20.500.12511/13121
dc.identifier.volume28
dc.identifier.wosWOS:001344544000001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthordel Pilar Laguna Pes, Maria
dc.institutionauthorid0000-0003-0906-4417
dc.relation.ecinfo:eu-repo/grantAgreement/EC/FP7/TA20nov-0011
dc.relation.ispartofProstate Cancer and Prostatic Diseases
dc.relation.publicationcategoryDiğer
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCryotherapy
dc.subjectElectroporation
dc.subjectHigh-Intensity Focused Ultrasound Ablation
dc.subjectProstatic Neoplasms
dc.subjectTreatment Outcome
dc.subjectTransrectal
dc.titleEstablished focal therapy-hifu, ire, or cryotherapy-where are we now?-a systematic review and meta-analysis
dc.typeOther

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