Partial gland ablation is an emerging treatment for localized prostate cancer. While whole-gland treatments with radical prostatectomy (RP) and radiation therapy are currently standards of care, these options are associated with significant tradeoffs in terms of functional outcomes, including urinary incontinence and erectile dysfunction [1]. Partial gland ablation may be an alternative treatment that achieves cancer control while attenuating the negative adverse effects of whole-gland treatment. However, there is an absence of high-level evidence comparing partial gland ablation to whole-gland therapies. The European Association of Urology guidelines recommend partial gland ablation therapy only within the context of a clinical trial or prospective registry [2].

To date, there has been only one comparative randomized trial of partial gland ablation [3], but this study compared vascular targeted phototherapy to active surveillance in a low-risk cohort, a group for which active surveillance is now the standard-of-care option [4]. Retrospective studies comparing partial gland cryoablation (PGC) and high-intensity focused ultrasound to whole-gland treatment have demonstrated similar oncologic outcomes between partial gland ablation and radical treatment [5], [6], [7]. However, follow-up after partial gland ablation relied on prostate-specific antigen (PSA) increases and suspicious findings on magnetic resonance imaging (MRI) and notably did not include surveillance biopsies, which are recommended according to contemporary expert consensus [8]. A recent prospective single-arm multicenter study demonstrated that the rate of recurrence of clinically significant prostate cancer among patients undergoing MRI-guided focused ultrasound surgery was 40% at 24 mo [9]. Lack of surveillance biopsies following partial gland ablation may result in underdetection of clinically significant prostate cancer.

There is a significant knowledge gap with regard to the oncologic efficacy of partial gland ablation in comparison to whole-gland therapies for intermediate-risk prostate cancer. Therefore, the aim of our study was to compare PGC and robot-assisted RP with regard to cancer outcomes. We hypothesized that PGC is associated with worse oncologic outcomes in comparison to RP.