Taimur T Shah1,2, Deepika Reddy3,4, Max Peters5, Daniel Ball4, Na Hyun Kim4, Enrique Gomez Gomez6, Saiful Miah7, David Eldred Evans3,4, Stephanie Guillaumier8, Peter S N van Rossum5, Marieke J Van Son5, Feargus Hosking-Jervis3, Tim Dudderidge9, Richard Hindley10, Amr Emara10, Stuart McCracken11,12, Damian Greene13, Raj Nigam14, Neil McCartan8, Massimo Valerio15, Suks Minhas4, Naveed Afzal16, Henry Lewi17, Chris Ogden18, Raj Persad19, Jaspal Virdi20, Caroline M Moore8, Manit Arya4,8, Mark Emberton8, Hashim U Ahmed3,4, Mathias Winkler3,4. 1. Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK. t.shah@imperial.ac.uk. 2. Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. t.shah@imperial.ac.uk. 3. Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK. 4. Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. 5. Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands. 6. Reina Sofia University Hospital/IMIBIC/University of Cordoba, Cordoba, Spain. 7. Department of Urology, Buckinghamshire NHS Trust, Wycombe Hospital, Wycombe, UK. 8. Department of Surgery and Interventional Sciences, University College London, and University College Hospital, London, UK. 9. Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK. 10. Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK. 11. Department of Urology, Sunderland Royal Hospital, Sunderland, UK. 12. Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. 13. Department of Urology, Spire Washington Hospital, Washington, UK. 14. Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK. 15. Urology Department, Lausanne University Hospital, Lausanne, Switzerland. 16. Department of Urology, Dorset County Hospital NHS Trust, Dorchester, UK. 17. Department of Urology, Springfield Hospital, Chelmsford, UK. 18. The Royal Marsden Hospital NHS Foundation Trust, London, UK. 19. Department of Urology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK. 20. Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK.
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.
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.
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