Introduction:

PGC is typically performed in an ambulatory setting and under general anesthesia, similarly to other ablation techniques. We explore performing PGC as an office-based procedure under local anesthesia. This may provide greater patient convenience and lower healthcare costs with similar outcomes to a general anesthesia approach.

Methods:

This prospective study included 55 men diagnosed with clinically significant prostate cancer (Grade group [GG] ≥ 2) who underwent in-office PGC under local anesthesia. MRI findings and targeted biopsy GG were used to characterize post-PGC oncological outcomes. Complications were graded using Common Terminology Criteria for Adverse Events (CTCAE) and urinary and sexual function at baseline, 4 and 9 months post-PGC were captured with the Expanded Prostate Cancer Index – Clinical Practice (EPIC-CP). Lower EPIC-CP scores indicate better urinary and sexual function. Finally, time-driven activity-based costing (TDABC) was used to determine healthcare costs of in-office PGC.

Results:

Median age was 70 years (interquartile range [IQR], 63.4-75) and median pre-treatment PSA was 6.6 ng/mL (IQR, 7.7-9.2). Forty-two men (83%) had PI-RADS category ≥ 4 lesions. Thirty-two (58.2%) men had GG 2, 13 (23.6%) had GG 3, seven (12.7%) had GG 4 and three (5.5%) had GG 5 on pre-treatment biopsy. Thirty-five men underwent MRI-targeted biopsy post-PGC. Twenty-two of these men (62.9%) had no cancer or GG1, and 13 (37.1%) men had GG ≥ 2 on post-PGC biopsy. Five (9.1%) men experienced CTCAE score 3 adverse events. Urinary and sexual function did not change significantly from baseline to 4-months (p=0.20 and p=0.08, respectively) and 9-months (p=0.23 and p=0.67, respectively) (Table 1). The median cost of in-office PGC was $4,463.05 (range $4,087.19-7,238.16).

Conclusion:

Our pilot study demonstrates that in-office PGC under local anesthesia is feasible, reproducible, and well tolerated by men with localized prostate cancer. In our series we demonstrate that in-office PGC has short-term oncological and functional outcomes comparable to HIFU and PGC under general anesthesia. However, longer-term follow-up is needed to demonstrate durable cancer control to improve patient selection.

Funding: N/A