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Vol. 42. Issue 6.
Pages 355-364 (July - August 2018)
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Vol. 42. Issue 6.
Pages 355-364 (July - August 2018)
Review article
Cryotherapy versus high-intensity focused ultrasound for treating prostate cancer: Oncological and functional results
Crioterapia frente a high intensity focused ultrasound en el tratamiento del cáncer de próstata: resultados oncológicos y funcionales
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F. Donis-Canet
Corresponding author
franciso.donis.uro@gmail.com

Corresponding author.
, M.D. Sánchez-Gallego, F. Arias-Fúnez, G. Duque-Ruíz, I. Laso, J. Brasero-Burgos, J. Lorca-Álvaro, V. Gómez-Dos Santos, R. Rodríguez-Patrón, F.J. Burgos-Revilla
Departamento de Urología, Hospital Ramón y Cajal, Madrid, Spain
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Table 1. Characteristics of the studies included in the systematic review.
Table 2. Oncological and functional results of HIFU.
Table 3. Oncological and functional cryotherapy results.
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Abstract
Context and objective

The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localized prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies.

Acquisition of evidence

A systematic literature review was conducted of the treatment of localized prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D’Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer.

Synthesis of the evidence

After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomized. The patients’ mean age was younger than 75 years.

Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6–100% for cryotherapy and 96–100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86–100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9–100%) and total therapy (39%). HIFU showed potency rates of 89%, 52–80% and 33–78% for focal therapy, hemiablation and total therapy, respectively.

Conclusions

Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centers with high volumes of patients.

Keywords:
Cryotherapy
Cryosurgery
High intensity focused ultrasound
HIFU
Prostate cancer
Resumen
Contexto y objetivo

El diagnóstico cada vez más precoz del cáncer de próstata obliga a buscar alternativas terapéuticas con buenos resultados oncológicos, que a su vez faciliten una buena calidad de vida a largo plazo. La presente revisión analiza los resultados de 2 terapias mínimamente invasivas en el tratamiento del cáncer localizado de próstata en cuanto a resultados oncológicos y funcionales, así como las complicaciones derivadas de los mismos.

Adquisición de la evidencia

Revisión sistemática de la literatura referida al tratamiento del cáncer localizado de próstata con 2 técnicas ablativas como terapia primaria: la criocirugía o crioterapia y el high intensity focused ultrasound (HIFU). Se incluyen pacientes con procedimientos que incluían la totalidad de la glándula, con hemiablación o con terapia focal e indicados en cáncer de próstata de bajo riesgo o riesgo intermedio según criterios D’Amico. Se excluyen pacientes con cáncer de próstata de alto riesgo, o aquellos que hayan recibido cualquier tratamiento previo para el cáncer de próstata.

Síntesis de la evidencia

Tras la búsqueda y exclusión de estudios que no cumplían los criterios del protocolo, se revisan un total de 14 estudios, con un total de 350 pacientes tratados mediante crioterapia, y un total de 1.107 pacientes tratados con HIFU. En todos los casos se trataron de estudios prospectivos o retrospectivos, no aleatorizados. La edad media de los pacientes fue de menos de 75 años.

En global la tasa de recidiva anatomopatológica en los pacientes tratados con crioterapia oscila entre el 13,2% y el 26%, mientras que en el HIFU oscilan entre el 7,3% y el 67,9%. La continencia global mostrada fue de un 97,6-100% en el caso de la crioterapia, y un 96-100% en el HIFU a los 12 meses. Respecto a las tasas de potencia sexual la crioterapia muestra una potencia completa del 86-100% a los 12 meses en pacientes tratados con crioterapia focal, y algo menores en la hemiablación (76,9-100%) y en la terapia total (39%). El HIFU reporta tasas de potencia del 89% 52-80% y 33-78% en terapia focal, hemiablación y terapia total respectivamente.

Conclusiones

Ambas técnicas presentan unos resultados funcionales equiparables, si bien los resultados oncológicos algo más pobres en el HIFU son reflejo de una curva de aprendizaje más complicada, que puede abocar su uso a centros con alto volumen de pacientes.

Palabras clave:
Crioterapia
Criocirugía
High intensity focused ultrasound
HIFU
Cáncer de próstata

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