Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study

Abstract

ImportanceFocal therapy involves treating only the cancerous area within the prostate rather than the whole gland. Comparative effectiveness data for oncological and functional outcomes are lacking. ObjectiveTo evaluate oncological and functional outcomes of focal therapy in comparison to radical prostatectomy in patients with clinically significant, non-metastatic prostate cancer. DesignA 1:1 propensity score matched study, reviewing patients undergoing focal therapy or radical prostatectomy between November 2005-September 2018. SettingProspective multicentre databases for focal therapy (high intensity focused ultrasound and cryotherapy) and radical prostatectomy were analysed for eligibility. ParticipantsPatients with PSA<20ng/ml, Gleason</=4+3 and stage</=T2c that underwent radical prostatectomy or focal therapy were matched for treatment year, age, PSA, Gleason score, T-stage, maximum cancer core length and neoadjuvant androgen deprivation therapy use. InterventionFocal therapy compared to radical prostatectomy. Main outcome and measuresPrimary outcome was failure-free survival (FFS) defined by need for salvage whole-gland or systemic therapy or metastases. Secondary outcomes were all-cause mortality, erectile and urinary functional outcomes. Results335/572 patients underwent radical prostatectomy, and 501/761 patients underwent focal therapy, high intensity focused ultrasound (n=626) and cryotherapy (n=135) were eligible for matching. After propensity score matching, 246 radical prostatectomy (mean [SD] age 63.4 [5.6] years, median [IQR]

High-Intensity Focused-Ultrasound Focal Therapy Versus Laparoscopic Radical Prostatectomy: A Comparison of Oncological and Functional Outcomes in Low- and Intermediate-Risk Prostate Cancer Patients

“…Focal therapy may be an option for them. Our data suggest that FT may be considered inferior to radical prostatectomy as far as treatment failure rates are concerned; however, observations based on bigger patient cohorts, published by Shah and Albissini, show that the oncological outcomes may actually be similar to radical treatment [6,8]. Furthermore, the occurrence of failure after FT does not preclude successful treatment.…”

“…The wide adoption of mpMRI in treatment-naive patients in recent years has led to more accurate detection of cancer foci and more careful patient selection [5]. According to the current literature, FT provides good cancer control [6][7][8] and is associated with excellent functional outcomes [7][8][9]. The rates of severe complications also seem to be lower than those of radical treatment modalities [10].…”

Focal therapy for localized prostate cancer – Current status

“…Oncological outcomes over the follow up period of 8 years were similar between the FT and RP ((FFS for FT was 83% (76%–90%) and that for RP was 79% (73%–86%) P = 0.12)). [ 34 ] Table 1 includes primary studies comparing FT to standard treatment options such as radical prostatectomy, radiotherapy and active surveillance.…”

Prostate Cancer: a comparison of focal therapy and radical prostatectomy

“…Focal therapy of prostate cancer (PCa) may have been born in the U.S. [1,2], but it has grown to late adolescence (although not full maturity) in the UK. Early observational studies from University and Imperial Colleges in London have helped make focal therapy a reasonable consideration for many men with PCa [3,4].…”