Background:In the evolving landscape of localized prostate cancer management, focal therapies such as high-intensity focused ultrasound (HIFU) and prostate gland cryoablation (PGC) have emerged as organ-sparing alternatives for patients with low- to intermediate-risk disease. While these strategies aim to preserve functional outcomes, comparative data against robot-assisted radical prostatectomy (RARP) remain scarce and heterogeneous.Methods:We conducted a prospective, single-center study evaluating oncologic and functional outcomes in patients with organ-confined prostate cancer (Grade Group ≤ 2) treated with HIFU (n= 49), PGC (n= 114), or RARP (n= 109). Outcomes were assessed using standardized definitions at a median follow-up of 22 months. Treatment failure was defined according to EAU guidelines, and Kaplan–Meier analysis was applied to time-to-event outcomes.Results:Focal therapy patients were older, more comorbid, and had lower baseline erectile function (eachp< 0.001). RARP was associated with the longest operative time but yielded the lowest complication rate (2.75% vs. 20.4% for HIFU and 31.5% for PGC;p< 0.001). Catheter-related morbidity was disproportionately higher in the PGC group. RARP conferred a longer time to treatment failure (p< 0.001), although continence and potency recovery at follow-up were comparable across groups. Notably, erectile function returned earlier among HIFU patients.Conclusions:While focal therapies offer promising early functional results with minimal perioperative risk, they are associated with earlier treatment failure and higher catheter-related morbidity, particularly after cryoablation. These findings underscore the need for individualized treatment strategies guided by standardized, comparative outcome frameworks.
背景：在局限性前列腺癌治疗不断发展的背景下，高强度聚焦超声（HIFU）和前列腺冷冻消融术（PGC）等局部治疗已成为低至中危患者的器官保留替代方案。尽管这些策略旨在保留功能预后，但与机器人辅助根治性前列腺切除术（RARP）的对比数据仍然稀缺且异质性较高。 方法：我们开展了一项前瞻性单中心研究，评估接受HIFU（n=49）、PGC（n=114）或RARP（n=109）治疗的器官局限性前列腺癌（分级分组≤2级）患者的肿瘤学和功能预后。在中位随访22个月时采用标准化定义进行评估。治疗失败依据欧洲泌尿外科学会指南定义，并对时间-事件结局进行Kaplan-Meier分析。 结果：局部治疗患者年龄更大、合并症更多且基线勃起功能更差（各项p<0.001）。RARP手术时间最长但并发症发生率最低（2.75% vs. HIFU 20.4% vs. PGC 31.5%；p<0.001）。PGC组导管相关并发症发生率显著更高。虽然各组随访期间的控尿功能和勃起功能恢复情况相当，但RARP组治疗失败时间更长（p<0.001）。值得注意的是，HIFU患者勃起功能恢复更早。 结论：尽管局部治疗在围手术期风险最小化的前提下展现出良好的早期功能预后，但其治疗失败时间更早且导管相关并发症发生率更高，这在冷冻消融术后尤为明显。这些发现强调需要在标准化比较性结局框架指导下制定个体化治疗策略。
肿瘤(癌症)患者之家