Comparative analysis of minimally invasive methods of treatment of localized prostate cancer

Abstract

The purpose of this work is to study the functional and oncological results of minimally invasive methods in patients with verified prostate cancer.Materials and methods. In our study, 160 patients with identified prostate cancer were presented, treatment was carried out with minimally invasive methods (methods of cryoablation (n = 53), brachytherapy (n = 52) and HIFU therapy (n = 55)). A qualitative assessment of the oncological outcome revealed high levels of prostate-specific antigen (PSA) and the results of repeated transrectal prostate biopsies. The evaluation of functional indicators and quality of life was carried out according to the results of the IIEF-5 (International Index of Erectile Function), IPSS (International Prostate Symptom Score), QoL (Quality of Life), Qmax (maximum urination rate of function).Results. The results of oncological control according to the data of positive repeated biopsies were worse in patients after cryoablation (7.54 %), the best indicators of oncological results were observed in patients after brachytherapy. Looking at the IPSS results, it is possible to detect statistical signs of higher scores in the brachytherapy group when various signs are found in the postoperative period, however, these differences do not reach statistical signs in the late period in patients of group brachytherapy and cryoablation. Patients of the cryoablation group showed higher levels of the IIEF-5 in the postoperative period, in the late period of observation of erectile function in patients of the cryoablation group, the statistical data did not differ from those in patients after brachytherapy. Patients after HIFU therapy showed a decrease in de novo erectile dysfunction over a 3-year follow-up period, above average IIEF5 scores, below IPSS scores, and better QoL results.Conclusion. Long-term oncological results are, in general, revisions, however, the recurrence rate is slightly higher in patients after cryoablation. Prostate cancer recurrence was detected in patients of the ISUP 3 group. In patients after HIFU therapy, the quality of urination is higher than in patients of other groups, which can be associated with the laser enucleation of prostate hyperplasia performed by him. The advantage in patients after HIFU therapy was observed in the detection of IIEF-5, thus HIFU therapy had a better effect on the quality of life of patients with pathological prostate cancer.

Keywords

• brachytherapy
• cryoablation
• high-intensity focused ultrasound therapy
• prostate cancer detection