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


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Deepika Reddy, Taimur Shah, Max Peters, Raj Persad, Manit Arya, Enrique Gomez-Gomes, Saiful Miah, David Eldred-Evans, Stephanie Guillaumier, Peter S.N. van Rossum, Marieke van Son, Feargus Hosking-Jervis, Tim Dudderidge, Richard Hindley, Emr Amara, Stuart McCracken, Damian Greene, Raj Nigam, Neil McCartan, Massimo Valerio, Suks Minhas, Naveed Afzal, Caroline Moore, Mark Emberton, Mathias Winkler, Hashim Ahmed

Abstract

Background

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

Method

Using prospective multicentre databases of 761 FT and 572 RP cases (November/2005-September/2018), patients with PSA <20ng/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 7.9g/ml (6-10) and median (IQR) follow-up 64 (30-89) months. For focal therapy, these were 63.3 (6.9) years, 7.9ng/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)

Conclusion

In select patients with non-metastatic prostate cancer, medium term oncological outcomes were similar between focal therapy and radical prostatectomy.

Impact statement

In this study, we demonstrated similar medium-term cancer control between focal therapy and radical prostatectomy.