A Systematic Review and Meta-Analysis of the CancerRelated 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

Objective: 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. Methods: 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). Results: 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. Conclusion: 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.