ABSTRACT
OBJECTIVES: To assess the comparative safety and effectiveness of 2 prostate cancer treatment ablationâ¯modalities: irreversible electroporation (IRE) and high-intensity focused ultrasound (HIFU).⯠METHODS: Two systematic literature reviews (SLRs) and meta-analyses (MAs) on IRE and HIFU were conductedâ¯inâ¯accordanceâ¯with PRISMAâ¯guidelines. Searches were conducted inâ¯PubMed and EMBASE.â¯Independent reviewers assessed literature eligibility and abstracted safety and effectiveness data. Oncological, safety, functional, and quality of life (QOL) outcomes were examined for each technology. MAs were conducted where data quality and availability allowed, using normal methods and a random/mixed effects model, and quality assessments performed. RESULTS: Fifty-fiveâ¯publications (nâ¯=â¯22 IRE; nâ¯=â¯33 HIFU) were included inâ¯the SLRs, and MAs were conducted on negative in-field post-procedure biopsy, prostate-specific antigen (PSA) level reduction, potency, urinary continence, and AE rate outcomes. MAs revealed that IRE patients had lower mean percent PSA level reductions, higher mean rates of in-field negative post-treatment biopsy, and higher rates of potency maintenance than HIFU patients. Most adverse events (AEs) reportedâ¯were comparable and minorâ¯(Grades I, II), with urinary tract infection, dysuria, hematuria, and incontinence or urgency most frequently reported.â¯The proportion of patients experiencing a severe AEâ¯(≥Grade III) ranged from 0 to 8%â¯after IREâ¯and HIFU. Both modalities were associated with positive functional outcomes as well as maintenance of QOL after treatment. CONCLUSIONS: Both IRE and HIFU were found to produce favorable effectiveness outcomes and have low complication rates while minimally impacting patient urinary and erectile function and maintaining overall QOL. These real-world findings can help guide clinical decision making and improve disease management for patients with prostate cancer.