Perioperative complications of focal therapy for prostate cancer: results from the GeRmAn Nationwide inpatient Data (GRAND) study

Objective To compare the perioperative complications of the most common focal therapy (FT) modalities for prostate cancer. Patients and Methods We assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2023, provided by the Research Data Center of the Federal Bureau of Statistics. We compared perioperative outcomes of high‐intensity focused ultrasound (HIFU), hyperthermia, irreversible electroporation of the prostate, cryotherapy, vascular photodynamic therapy of the prostate (VTP), and transurethral ultrasound ablation, as well as HIFU vs non‐HIFU treatments in general. Furthermore, we evaluated the role of concomitant transurethral resection of the prostate (TURP) on perioperative complications. Finally, the complication rate of FT was also compared to brachytherapy and robot‐assisted radical prostatectomy. Results A total of 10 544 underwent FT. Most patients received HIFU (92%). The number of FT cases performed annually has been steadily decreasing. The most prevalent complication (9.6%) was urinary tract infection (HIFU: 10%, hyperthermia: 6.2%, cryotherapy: 6.8%, VTP: 3.9%). Haematuria was observed in 3.6% of all cases. In the multivariable regression, HIFU was associated with higher rates of urinary tract infections (10% vs 5.2%, P < 0.001) but lower rates of haematuria (3.4% vs 5.5%, P < 0.001) and admission to the intensive care unit (0.7% vs 2.2%, P < 0.001) compared to non‐HIFU procedures. Concomitant TURP was associated with higher transfusion ( P < 0.001), haematuria ( P < 0.001), sepsis ( P = 0.001), and urinary retention rates ( P = 0.03). Most perioperative complications were statistically significantly worse in patients undergoing FT compared to brachytherapy, while most perioperative complications were better after FT vs robot‐assisted radical prostatectomy. Conclusions In the largest epidemiological comparative study on the risk of complications of the most common FT for prostate cancer, we were able to show an overall low risk of perioperative complications.