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Background <p>Whether cryoablation and high-intensity focused ultrasound (HIFU) provide distinct advantages in hemigland ablation for localized prostate cancer (PCa) is unresolved.</p> Methods <p>A prospective FT-PCa registry (2021–2025) was analysed, identifying 258 men treated with hemigland ablation (cryoablation <i>n</i> = 179; HIFU <i>n</i> = 79). Baseline differences were addressed through inverse-probability-of-treatment weighting based on age, PSA, PSA density, ISUP, PI-RADS, lesion size, % of positive cores and prostate volume. Weighted Kaplan–Meier estimators, log-rank tests and Cox models were used for time-to-event outcomes; perioperative and functional variables were compared using design-based t-tests and Rao–Scott χ² tests. Primary endpoints were failure-free survival (FFS) and biochemical failure-free survival (BFS). A subgroup analysis excluding low-risk disease was additionally performed.</p> Results <p>Weighting achieved excellent covariate balance (all standardized mean differences &lt; 0.10). Perioperative outcomes were similar, including operative time (<i>p</i> = 0.41) and complications (<i>p</i> = 0.49). At 12 months, continence (97.9% vs. 97.7%; <i>p</i> = 0.94), spontaneous potency (41.2% vs. 36.5%; <i>p</i> = 0.41), overall potency (49.4% vs. 45.4%; <i>p</i> = 0.48), IIEF-5 (<i>p</i> = 0.48) and preservation indices (<i>p</i> &gt; 0.7) were comparable. IPSS scores showed no significant difference after weighting (<i>p</i> = 0.54). At 24 months, FFS (89.3% vs. 87.8%; weighted log-rank <i>p</i> = 0.66) and BFS (87.9% vs. 85.6%; weighted log-rank <i>p</i> = 0.79) showed no significant differences, and Cox models revealed no independent hazard signal. Cancer-specific, metastasis-free and overall survival each exceeded 95% (all <i>p</i> &gt; 0.7). Findings were unchanged after excluding low-risk patients.</p> Conclusions <p>In this propensity-weighted comparison of hemigland FT, cryoablation and HIFU yielded comparable outcomes. When case-mix is balanced, energy modality exerts minimal influence on short-term cancer control or functional recovery.</p>

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Hemigland cryoablation versus high-intensity focused ultrasound for localized prostate cancer: a propensity-weighted comparison of functional and oncologic outcomes

  • 期刊论文

  • 发表日期：

    2026年3月26日

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  • Umberto Anceschi,
  • Salvatore Basile,
  • Leonardo Misuraca,
  • Riccardo Mastroianni,
  • Simone D’Annunzio,
  • Flavia Proietti,
  • Alfredo Maria Bove,
  • Francesco Prata,
  • Riccardo Capecchi,
  • Giuseppe Spadaro,
  • Mariaconsiglia Ferriero,
  • Franco Lugnani,
  • Giuseppe Simone

摘要

Background

Whether cryoablation and high-intensity focused ultrasound (HIFU) provide distinct advantages in hemigland ablation for localized prostate cancer (PCa) is unresolved.

Methods

A prospective FT-PCa registry (2021–2025) was analysed, identifying 258 men treated with hemigland ablation (cryoablation n = 179; HIFU n = 79). Baseline differences were addressed through inverse-probability-of-treatment weighting based on age, PSA, PSA density, ISUP, PI-RADS, lesion size, % of positive cores and prostate volume. Weighted Kaplan–Meier estimators, log-rank tests and Cox models were used for time-to-event outcomes; perioperative and functional variables were compared using design-based t-tests and Rao–Scott χ² tests. Primary endpoints were failure-free survival (FFS) and biochemical failure-free survival (BFS). A subgroup analysis excluding low-risk disease was additionally performed.

Results

Weighting achieved excellent covariate balance (all standardized mean differences < 0.10). Perioperative outcomes were similar, including operative time (p = 0.41) and complications (p = 0.49). At 12 months, continence (97.9% vs. 97.7%; p = 0.94), spontaneous potency (41.2% vs. 36.5%; p = 0.41), overall potency (49.4% vs. 45.4%; p = 0.48), IIEF-5 (p = 0.48) and preservation indices (p > 0.7) were comparable. IPSS scores showed no significant difference after weighting (p = 0.54). At 24 months, FFS (89.3% vs. 87.8%; weighted log-rank p = 0.66) and BFS (87.9% vs. 85.6%; weighted log-rank p = 0.79) showed no significant differences, and Cox models revealed no independent hazard signal. Cancer-specific, metastasis-free and overall survival each exceeded 95% (all p > 0.7). Findings were unchanged after excluding low-risk patients.

Conclusions

In this propensity-weighted comparison of hemigland FT, cryoablation and HIFU yielded comparable outcomes. When case-mix is balanced, energy modality exerts minimal influence on short-term cancer control or functional recovery.