# A Systematic Review and Meta-Analysis of the Cancer-Related and Functional Outcomes of High-Intensity Focused Ultrasound, Open Radical Prostatectomy, Robot Assisted Radical Prostatectomy, and External Beam Radiation Therapy in Primary Treatment of Localized Low- or Intermediate-Risk Prostate Cancer

## TL;DR

This study compares the effectiveness and side effects of four prostate cancer treatments for localized low- or intermediate-risk cases.

## Contribution

The paper provides a systematic review and meta-analysis comparing HIFU, ORP, RARP, and RT for prostate cancer treatment.

## Key findings

- ORP showed better 5-year failure-free survival than RT.
- ORP had lower urinary incontinence rates than RARP at 1 year.
- RARP had better erectile function outcomes than ORP at 1 year.

## Abstract

Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP), robot-assisted radical prostatectomy (RARP), and external beam radiation therapy (RT) in the treatment of localized low- and intermediate-risk prostate cancer.

We searched bibliographic databases for case–control, cohort, and randomized controlled studies. We used MeSH subject headings and free text terms for prostate cancer, HIFU, ORP, RARP, RT, failure-free survival (FFS), biochemical disease-free survival (BDFS), urinary incontinence (UI), and erectile dysfunction (ED).

Fourteen studies were included in the review, for a total of 34 927 participants. Among the 8 studies of HIFU as the primary treatment of localized low- and intermediate-risk prostate cancer, 4 studies reported 5-year FFS rates ranging from 67.8% to 97.8%, 3 studies reported 5-year BDFS ranging from 58% to 85.4%, 5 studies reported 1-year UI rates ranging from 0% to 6%, and 4 studies reported 1-year ED rates ranging from 11.4% to 38.7%. Furthermore, our search revealed a 5-year FFS benefit favoring ORP compared to RT, a 1-year UI rate favoring ORP compared to RARP, and a 1-year ED rate favoring ORP compared to RARP.

Our systematic review and meta-analysis revealed lack of studies with active comparators comparing HIFU to standard of care (ORP, RARP, or RT) in primary treatment of localized low- and intermediate-risk prostate cancer. Open radical prostatectomy has favorable efficacy outcomes compared to RT, while RARP has beneficial functional outcomes compared to ORP, respectively.