The Role of Percentage of Prostate-specific Antigen Reduction After Focal Therapy Using High-intensity Focused Ultrasound for Primary Localised Prostate Cancer. Results from a Large Multi-institutional Series.

Focal therapy (FT) for prostate cancer (PCa) is emerging as a novel therapeutic approach for patients with low- to intermediate-risk disease, in order to provide acceptable oncological control, whilst avoiding the side effects of radical treatment. Evidence regarding the ideal follow-up strategy and the significance of prostate-specific antigen (PSA) kinetics after treatment is needed. In this study, we aimed to assess the value of the percentage of PSA reduction (%PSA reduction) after FT in predicting the likelihood of any additional treatment or any radical treatment. We retrospectively analysed a multicentre cohort of 703 men receiving FT for low- and intermediate-risk PCa. Overall, the rates of any additional treatment and any radical treatment were 30% and 13%, respectively. The median follow-up period was 41 mo. The median %PSA reduction after FT was 73%. At Cox multivariable analysis, %PSA reduction was an independent predictor of any additional treatment (hazard ratio [HR]: 0.96; p < 0.001) and radical treatment (HR: 0.97; p < 0.001) after FT. For %PSA reduction of>90%, the probability of any additional treatment within 5 yr was 20%. Conversely, for %PSA reduction of <10%, the probability of receiving any additional treatment within 5 yr was roughly 70%. This study is the first to assess the role of %PSA reduction in the largest multicentre cohort of men receiving FT for PCa. Given the lack of standardised follow-up strategies in the FT field, the use of the %PSA reduction should be considered. PATIENT SUMMARY: The percentage of prostate-specific antigen reduction is a useful tool to assess men following focal therapy (FT). It can assist the urologist in setting up an appropriate follow-up and during post-FT patient counselling.

European urology. 2020 May 19 [Epub ahead of print]

Armando Stabile, Clement Orczyk, Francesco Giganti, Marco Moschini, Clare Allen, Shonit Punwani, Nathalie Cathala, Hashim U Ahmed, Xavier Cathelineau, Francesco Montorsi, Mark Emberton, Alberto Briganti, Rafael Sanchez-Salas, Caroline M Moore

Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. Electronic address: ., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK., Division of Surgery and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France., Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.