Impact of Focal Versus Whole Gland Ablation for Prostate Cancer on Sexual Function and Urinary Continence


Central to the concept of focal therapy is that patients are trading certainty of a cure for a reduction in side effects.  Supporting evidence is provided by Borges et al., who hypothesized that patients treated with focal therapy (FT) would have better functional outcomes as compared to patients undergoing whole-gland therapy (WGT) using HIFU or cryoablation. The authors performed a single-center retrospective comparison of 195 FT (60% HIFU) and 105 WGT (81% HIFU) with 12 months follow-up.  Among the focal therapy group, the majority received hemi-gland ablation (87%). Cancers treated were mainly GG1 (71%), making this a poor cohort to evaluate oncologic outcomes.  The authors defined urinary continence 0 pads, and potency as sexual penetration ± PDE5-inhibitor. There was similar urinary function between FT and WGT as assessed IPSS, but better continence for the FT cohort. There was a significant difference in sexual function between cohorts following treatment (Fig 1). Potency at 12 months favored focal therapy 81% vs 62%, and persisted on multivariate analysis (OR 4.2).

IIEF in whole vs. focal HIFU.