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Focal treatment of prostate cancer: Early functional and oncological outcomes from a single center

Grant number: 23/11378-6
Support Opportunities:Scholarships in Brazil - Scientific Initiation
Effective date (Start): January 01, 2024
Effective date (End): December 31, 2024
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal Investigator:Ariê Carneiro
Grantee:Cristiane Andres de Castro
Host Institution: Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE). Sociedade Beneficente Israelita Brasileira Albert Einstein (SBIBAE). São Paulo , SP, Brazil

Abstract

Prostate cancer (PCa) is the most prevalent solid tumor among men. PCa has a very heterogeneous presentation with insidious evolution. Radical treatments for patients with localized PCa include prostatectomy and radiotherapy. The increasing knowledge regarding the shortcomings of these modalities has led to research for alternate therapies with comparable rates of cancer control and lower treatment-related morbidity. Focal therapy for localized CaP has been increasingly studied and has shown promising results. The objective of this treatment is to offer the patient an effective and less aggressive treatment. Despite the scarce long-term oncological and functional data, focal therapy have been indicated as an alternative to both radiotherapy and surgery in order to reduce the adverse effects of radical treatment, such as erectile dysfunction and urinary incontinence.Focal therapy with high-intensity ultrasound (HIFU) has been widely used in Europe. It acts through ultrasonic waves promoting mechanical and thermal effects with high temperatures, leading to necrosis by coagulation and cavitation. HIFU was approved by the Food and Drug Administration (FDA) as a non-invasive therapy, ablative therapy without the use of punctures and that does not use ionizing radiation. HIFU has been growing exponentially as an non-invasive alternative therapy to localized prostate cancer.The literature shows discrepant results regarding oncological and functional outcomes of HIFU. The interpretation of these findings is challenging, due to the heterogeneity of the selection of patients among the studies and also the non-uniform follow-up time. The importance of our study with a retrospective design is to collect data that allow a better understanding of the functional and oncological outcomes of HIFU therapy, its limitations and the profile of the most appropriate candidate for this therapeutic modality.Thus, the objectives of this study are to analyze the early functional and oncological outcomes of HIFU treatment, as well as the rate of complications the PSA curve.A retrospective single-center cohort study of patients undergoing focal therapy for the treatment of localized prostate cancer will be performed. Patients who underwent focal therapy with HIFU at Hospital Municipal Dr. Gilson de Cássia Marques de Carvalho - Vila Santa Catarina/Hospital Israelita Albert Einstein from October 2020 (beginning of HIFU treatment at the institution) to October 2023 will be included. The outcomes to be analyzed will be the evaluation of functional preservation (erectile function and urinary continence) through the EPIC-CP questionnaire (Expanded Prostate Cancer Index Composite for Clinical Practice), rates of cancer treatment failure, as well as the complication rates and PSA curve at baseline and three and six months of follow-up.

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