In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment. We evaluated the role of focal therapy (FT) in patients 70 years and older as an alternative management modality.
649 patients across 11 UK sites receiving focal high intensity focused ultrasound (HIFU) or cryotherapy between June 2006 - July 2020 reported within the UK based HIFU Evaluation and Assessment of Treatment and the International Cryotherapy Evaluation (ICE) registries were evaluated. Primary outcome was failure free survival (FFS) defined by need for more than 1 focal re-ablation, progression onto radical treatment, development of metastases, need for systemic treatment or prostate cancer specific death. This was compared to the FFS in patients undergoing radical treatment via a propensity score weighted analysis.
Median age was 74 years (IQR: 72, 77) and median follow-up 24 months (IQR: 12, 41). 60% had intermediate risk disease and 35% high risk disease. 113 patients (17%) required further treatment. 16 had radical treatment and 44 required systemic treatment. FFS was 82% (95% CI: 76-87%) at 5 years. Comparing patients who had radical therapy to those who had focal therapy, 5-year FFS was 96%, (95% CI: 93-100%) and 82% (95% CI: 75-91%) respectively, P < .001. 93% of those in the radical treatment arm had received Radiotherapy as their primary treatment with its associated use of Androgen Deprivation Therapy (ADT) thereby leading to potential over estimation of treatment success in the radical treatment arm, especially given the similar metastases free and overall survival rates seen.
We propose FT to be an effective management option for the older or comorbid patient who is unsuitable for or not willing to undergo radical treatment.
The Journal of urology. 2023 Apr 04 [Epub ahead of print]
David Habashy, Deepika Reddy, Max Peters, Taimur T Shah, Marieke van Son, Peter van Rossum, Mariana Bertoncelli Tanaka, Emma Cullen, Ryan Engle, McCracken Stuart, Damian Greene, Richard G Hindley, Amr Emara, Raj Nigam, Clement Orczyk, Iqbal Shergill, Raj Persad, Jaspal Virdi, Caroline M Moore, Manit Arya, Mathias Winkler, Mark Emberton, Hashim U Ahmed, Tim Dudderidge
Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom., Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom., Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands., Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom., Department of Urology, Sunderland Royal Hospital, City Hospital Foundation Trust, United Kingdom., Department of Urology, Spire Hospital, Washington, United Kingdom., Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom., Department of Urology, Royal Surrey NHS Foundation Trust, United Kingdom., Department of Surgery and Interventional Sciences, University College London, and University College Hospital London, London, United Kingdom., Department of Urology, Wrexham Maelor Hospital, United Kingdom., North Bristol NHS Trust, Westbury on Trym, Bristol, United Kingdom., Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom.