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Contemporary Patterns of Local Ablative Therapies for Prostate Cancer at United States Cancer Centers: Results from a National Registry - Beyond the Abstract

Local ablative therapies or focal therapy as it is called in other settings defines a noninvasive technique aiming to destroy small tumors inside the organ while leaving the remaining organ intact and sparing most of its normal tissue. These therapies aim to provide adequate cancer control while minimizing side effects for patients. Against the backdrop of innovative image-based detection and diagnosis, mostly driven by magnetic resonance imaging (MRI) and MRI-targeted biopsy, the targeted treatment of focal tumors (tumors with one focus or only one affected area) has garnered increasing attention in urological oncology.

We found focal therapies like cryoablation and radiofrequency ablation have gained importance due to changing patients' characteristics and age, especially in renal cell cancer patients. In contrast, for prostate cancer, there still was a knowledge gap regarding real-world uptake of these techniques among men in the United States.1 Considering that the American Urological Association (AUA) and European Association of Urology (EAU) guidelines now recommend ablative approaches for patients with an increased risk of surgical morbidity, we aimed to provide the first analyses of trends of local ablative therapy for prostate cancer in the United States.2,3

To clarify the “who, where, and when” we conducted a retrospective study of men treated for localized prostate cancer between 2010 and 2017 in the US.4 We analyzed patient and hospital-level factors that might be associated with receiving local ablative therapy. We identified a trend towards older and multimorbid patients being more likely to receive local ablative therapy as a primary approach and found intermediate risk prostate cancer was more likely to be treated with local ablative therapy. Finally, academic and research centers occurred to be less likely to conduct local ablative therapy.

This study was one of the first to understand geographic and time trends in local ablative therapy utilization and will help inform policies in the early period of adoption of these techniques. Future investigation should include non-hospital-based settings and investigate the enrollment and access of participants for local ablative therapy.

Written by: Mara Koelker, MD, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA and University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany

References:

  1. Ginzburg, S., Tomaszewski, J. J., Kutikov, A.: Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy. Nature Reviews Urology, 14: 669, 2017
  2. Ljungberg, B., Albiges, L., Abu-Ghanem, Y. et al.: European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol, 75: 799, 2019
  3. Campbell Steven, C., Novick Andrew, C., Belldegrun, A. et al.: Guideline for Management of the Clinical T1 Renal Mass. J Urol, 182: 1271, 2009
  4. Koelker, M., Labban, M., Frego, N. et al.: Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers: results from a national registry. World J Urol, 2023
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