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

Abstract

INTRODUCTION:

Focal therapy (FT) ablates areas of prostate cancer rather than treating the whole gland. We compared oncological outcomes of FT to radical prostatectomy (RP).

METHODS:

Using prospective multicentre databases of 761 FT and 572 RP cases (November/2005-September/2018), patients with PSA < 20 ng/ml, Gleason </= 4 + 3 and stage </= T2c were 1-1 propensity score-matched for treatment year, age, PSA, Gleason, T-stage, cancer core length and use of neoadjuvant hormones. FT included 1-2 sessions. Primary outcome was failure-free survival (FFS) defined by need for salvage local or systemic therapy or metastases. Differences in FFS were determined using Kaplan-Meier analysis with log-rank test.

RESULTS:

335 radical prostatectomy and 501 focal therapy patients were eligible for matching. For focal therapy, 420 had HIFU and 81 cryotherapy. Cryotherapy was used predominantly for anterior cancer. After matching, 246 RP and 246 FT cases were identified. For radical prostatectomy, mean (SD) age was 63.4 (5.6) years, median (IQR) PSA 7.9 g/ml (6-10) and median (IQR) follow-up 64 (30-89) months. For focal therapy, these were 63.3 (6.9) years, 7.9 ng/ml (5.5-10.6) and 49 [34-67] months, respectively. At 3, 5 and 8 years, FFS (95%CI) was 86% (81-91%), 82% (77-88%) and 79% (73-86%) for radical prostatectomy compared to 91% (87-95%), 86% (81-92%) and 83% (76-90%) following focal therapy (p = 0.12).

CONCLUSIONS:

In patients with non-metastatic low- intermediate prostate cancer, oncological outcomes over 8 years were similar between focal therapy and radical prostatectomy.

• Authors: Taimur T Shah, Deepika Reddy, Max Peters, Daniel Ball, Na Hyun Kim, Enrique Gomez Gomez, Saiful Miah, David Eldred Evans, Stephanie Guillaumier, Peter S N van Rossum, Marieke J Van Son, Feargus Hosking-Jervis, Tim Dudderidge, Richard Hindley, Amr Emara, Stuart McCracken, Damian Greene, Raj Nigam, Neil McCartan, Massimo Valerio, Suks Minhas, Naveed Afzal, Henry Lewi, Chris Ogden, Raj Persad, Jaspal Virdi, Caroline M Moore, Manit Arya, Mark Emberton, Hashim U Ahmed, Mathias Winkler
• Journal: Prostate cancer and prostatic diseases (Prostate Cancer Prostatic Dis) Vol. 24 Issue 2 Pg. 567-574 (06 2021) ISSN: 1476-5608 [Electronic] England
• PMID: 33504940 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Case-Control Studies
• Cryotherapy (mortality)
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prognosis
• Propensity Score
• Prospective Studies
• Prostatectomy (mortality)
• Prostatic Neoplasms (pathology, surgery)
• Survival Rate