Functional outcomes and biochemical control after radical prostatectomy versus irreversible electroporation for localized prostate cancer.

Treatment selection for localized prostate cancer requires balancing oncologic control against urinary and sexual function. We retrospectively compared 32 men undergoing laparoscopic bilateral nerve-sparing radical prostatectomy (RP) with 18 undergoing focal irreversible electroporation (IRE), using unweighted and inverse probability of treatment weighting analyses. IRE was associated with shorter operative time and less frequent early urinary incontinence and sexual function decline. At 12 months after weighting, urinary incontinence occurred in 6.0% after RP and 0% after IRE, while sexual function decline occurred in 40.0% and 4.1%, respectively. Biochemical recurrence was more frequent after IRE than RP at 12 months (28.6% versus 8.0%). These findings suggest a trade-off between early functional preservation and biochemical control and should be interpreted as hypothesis-generating because of the retrospective single-center design, small sample, non-equivalent recurrence definitions, and short follow-up.