5-year cancer control comparable for focal therapy, RP

Chicago-A multicenter study in the United Kingdom found 5-year prostate cancer control rates following treatment with focal therapy are similar to those of patients who have undergone radical prostatectomy, even when accounting for variation in tumor location, size, and risk.

The study, presented at the 2019 AUA annual meeting in Chicago, showed no significant difference in failure-free survival-defined as the absence of a relapse, non-relapse mortality, or addition of another systemic therapy-between focal therapy and radical prostatectomy 5 years after either procedure.

It points to comparable medium-term results between focal therapy, which has fewer side effects and jeopardizes less healthy tissue, and radical prostatectomy.

Based on the results, “We should be talking about the harm aspects of surgery,” Deepika Reddy, MD, a urology surgeon for NHS in London, told 2019 AUA attendees.

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While focal therapy has a low side-effect profile, there has been uncertainty regarding its medium-length potential to control prostate cancer compared with radical approaches. In the United Kingdom, focal therapy for prostate cancer comprises high-intensity frequency ultrasound (HIFU) and focal cryotherapy based on cancer characteristics and location. The authors aimed to compare cancer control rates from this approach with those of radical prostatectomy.

Following National Institute for Health and Care Excellence guidance, the authors reviewed multicenter prospective cancer registries to identify men who underwent either HIFU (625 men) or cryotherapy (122) and laparoscopic radical prostatectomy (571) from 2007 to 2017.

“Up to two focal therapy sessions were allowed,” Dr. Reddy said.

From there, the authors used propensity scoring to match men who underwent focal therapy (either HIFU or cryotherapy) with their nearest radical prostatectomy patient match. Among the inclusion criteria were PSA <20 ng/mL; Gleason score £7, and T-stage £T2c. Exclusion criteria were missing matched variables and early adjuvant therapy within 1 year. The authors then matched patients by age, PSA, grade, maximum cancer core length, unilateral/bilateral disease, neoadjuvant hormone use, and treatment year.

After accounting for inclusion and exclusion criteria, the group included 420 HIFU patients, 81 cryotherapy patients, and 346 localized radical prostatectomy patients. Matching of patients led to 183 men in each cohort.

“This led to a well-matched cohort,” Dr. Reddy said.

Next: No difference in failure-free survivalNo difference in failure-free survival

During each of the time frames studied, the authors found no difference in failure-free survival rates between the HIFU/cryotherapy and localized radical prostatectomy groups. Focal therapy demonstrated an 88% failure-free survival rate over 5 years, while the 5-year failure-free survival rate for localized radical prostatectomy was 85%.

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There are limitations to the study, Dr. Reddy said. For example, certain variables, such as tumor volume, were not captured, although maximum cancer core length as a surrogate marker of tumor volume was used.

While long-term data around the efficacy of focal therapy compared with radical prostatectomy are still needed, the results provide the basis for conversations with patients around treatment options, she said.