The authors of this study add to the literature with regards to their experience with focal therapy. In this study, they compare the outcomes of patients treated with focal therapy (FT) and robotic prostatectomy (RARP) over a 6-year period (2009-2015). 1883 patients underwent RARP and 373 had FT - from those, we selected 1458 participants (1222 RARP and 236 FT) based on the National Comprehensive Cancer Network (NCCN) PCa risk classification:
402 (27.5%) patients were very low risk, 388 (26.6%) were low risk and 668 (45.8%) were intermediate risk. As for the type of FT, 188 men underwent HIFU and 48 had cryotherapy.
- Patient selection: excluded high-risk patients
- While not shown, the presenter indicated that the two groups were very similar in demographics
The assessed the following outcomes: Biochemical recurrence (BCR) free survival (using Phoenix definition for FT and PSA ≥ 0.2 ng/dl in RARP), the need for further treatment or intervention, FT failure (defined as positive control biopsy after treatment), overall survival (OS) and metastasis free survival (MFS). Complications were graded by the Clavien-Dindo classification system. Functional outcomes were assessed with validated questionnaires for genitourinary symptoms and sexual function.
- Biopsy was done 6-12 months after initial treatment. No specific imaging prior to biopsy.
Median follow-up for the group was 45.4 months (IQR 25.3-65.5).
Oncologic outcomes:
- BCR free survival: No difference. (89.4% vs 91% at 20 mo; p = 0.69)
- FT Failure: 61 (25.8%) patients, 46 (24.4%) with HIFU and 15(31.2%) with cryotherapy. In patients with positive biopsy, cancer was seen in the treated lobe in 42 men, while 19 patients had bilateral positive biopsy cores and 10 patients had positive biopsies in the contralateral lobe
- Need for additional treatments: FT was associated with higher risk of additional treatments (HR 5.21; 95% CI, 3.7-7.35; p < 0.001)
- OS and MFS: No difference
- Complications: FT patients had more all-grade complications (15.3% vs 9% for RARP; p = 0.004). However, the presenter did confirm that it had significantly less Gr 3-4 complications
Functional outcomes: RARP was associated with less continence recovery and lower potency rates at 3, 6, and 12 months. Table below highlights the comparison.
While the authors are quick to say that RARP and FT have similar oncologic benefit (albeit with more complications in FT, but better functional outcomes), the abstract and presentation lacked details about the methodology to know if an accurate comparison can be made. Further clarification and longer follow-up is required.
Speaker: S. Garcia Barreras
Co-Author(s): Sanchez-Salas R., Sivararam A., Secin F., Redondo C., Velilla G., Barret E., Nunes-Silva I., Srougi V., Baghdadi M., Galiano M., Rozet F., Cathala N., Mombet A., Prapotnich D., Cathelineau X.
Institution(s):
1. Institut Mutualiste Montsouris, Dept. of Urology, Paris, France
2. Memorial Sloan Kettering, Dept. of Urology, New York, United States of America
3. CEMIC, Dept. of Urology, Buenos Aires, Argentina
Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd
at the #EAU17 - March 24-28, 2017- London, England