SIU 2017: Prospective Comparative Analysis of Oncologic and Functional Outcomes Between Focal Therapy and Robotic Radical Prostatectomy

Lisbon, Portugal ( Focal therapy for localized prostate cancer has had increasing recognition and acceptance. However, while short term outcomes appear adequate, long-term data is still pending. By reducing impact on functional quality of life in men with low-volume disease, they help address a patient population often stuck between active surveillance and radical treatment. The ideal patient is not yet clear though, nor is the appropriate follow-up and triggers for reintervention/radical therapy.

In this study, the group from France adds their experience comparing focal therapy (FT) to robotic prostatectomy (RP) for localized low-risk and intermediate-risk prostate cancer. However, to be clear, this was NOT a prospective study. Over a 6 year period, 1883 men underwent RP while 373 had FT. Of these, they selected (unclear selection criteria, may have meant propensity matched) 1458 patients (1222 RP and 236 FT) for analysis – stratified by NCCN criteria – very low risk, low risk and intermediate risk. 188 had HIFU and 48 had cryotherapy. Oncologic outcomes were assessed – BCR-free survival, need for additional therapy, metastasis-free survival, and overall survival. FT failure was defined as any positive biopsy. Functional outcomes were assessed by pre-operative, 3 month, 6 month and 12-month validated questionnaires (IPSS, ICS, and IIEF-5).

Median follow-up was 45.4 months (almost 4 years). Main outcome scores are listed below:

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Important take-home: Patients undergoing RP had significantly worse continence and sexual function than FT patients.

FT failure was seen in 24.4% of HIFU patients and 31.2% of the cryotherapy patients – what salvage therapy they got is unknown. They do note that FT failure was seen in the treated lobe primarily (42 patients), 10 patients only in the contralateral lobe, and 19 patients in both lobes. The high local failure rate is concerning for the efficacy of therapy. FT also had higher rate of complications – 15.3% to 9%, though the grade of complications is unknown.

In terms of oncologic outcomes, BCR-free survival was the same – though it is uncertain if patients who had subsequent salvage therapy after FT failure were censored or included. At 5 years, approximately 30% of FT patients had received additional interventions. Overall survival was also similar between the groups – with the same caveat as before.

While interesting, and in line with prior results, more rigorous analysis is required and even longer-term data. The authors need to clarify if this was an ITT analysis or not, when it comes to BCR-free survival and overall survival.

Speaker(s): Silvia García Barreras, France

Institution(s): L’Institut Mutualiste Montsouris, France

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd, at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal