Real-world functional and oncologic outcomes of prostate gland ablation vs. standard of care therapies for localized prostate: A retrospective cohort study using the TriNetX database.

BACKGROUND AND

OBJECTIVE

Prostate gland ablation (PGA), including cryoablation, high intensity focused ultrasound (HIFU), and irreversible electroporation (IRE), treats localized prostate cancer while minimizing side effects compared to standard treatments. This study assessed functional and oncologic outcomes of PGA vs. radical prostatectomy (RP), external beam radiation therapy (EBRT), and surveillance.

METHODS

Men aged ≥18 with localized prostate cancer (T1-T2, N0, M0) treated from 2010 to 2023 were identified from TriNetX. Propensity score matching was applied per comparison. Functional outcomes (erectile dysfunction, urinary incontinence, urinary retention) and failure-free survival (FFS), defined as absence of repeat PGA, RP, EBRT, or androgen deprivation therapy, were analyzed using Kaplan-Meier and Cox models.

KEY FINDINGS AND LIMITATIONS: Among 214,411 patients, PGA was associated with lower early (0-2 years) risk of erectile dysfunction (HR: 0.66; 95% CI: 0.58-0.75) and urinary incontinence (HR: 0.51; 95% CI: 0.42-0.62) vs. RP, but higher urinary retention (HR: 2.80; 95% CI: 2.34-3.45). Compared to EBRT, PGA showed lower late (2-5 years) erectile dysfunction risk (HR: 0.70; 95% CI: 0.49-0.98). Five-year FFS was lower for PGA than RP (73.4% vs. 86.9%, P < 0.0001) and EBRT (73.3% vs. 88.5%, P < 0.0001). Limitations include retrospective design, platform constraints, and coding variability.

CONCLUSIONS AND CLINICAL IMPLICATIONS: PGA is associated with lower risk of early (<2 years) erectile dysfunction and incontinence compared to RP and reduced delayed (2-5 years) erectile dysfunction risk compared to EBRT. These findings, along with increased 5-year FFS failure risk, offer real-world data to guide patient counseling.