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Comparative Study
. 2021 Dec;24(4):1120-1128.
doi: 10.1038/s41391-021-00369-6. Epub 2021 May 1.

Conventional radical versus focal treatment for localised prostate cancer: a propensity score weighted comparison of 6-year tumour control

Marieke J van Son  1   2   3 , Max Peters  4   5 , Deepika Reddy  4 , Taimur T Shah  4   6 , Feargus Hosking-Jervis  4 , Stephen Robinson  7 , Jan J W Lagendijk  5 , Stephen Mangar  8 , Tim Dudderidge  9 , Stuart McCracken  6 , Richard G Hindley  10 , Amr Emara  10 , Raj Nigam  11 , Raj Persad  12 , Jaspal Virdi  13   14 , Henry Lewi  15 , Caroline Moore  16   17 , Clement Orczyk  16   17 , Mark Emberton  16   17 , Manit Arya  4   8   13   14   17 , Hashim U Ahmed  4   8 , Jochem R N van der Voort van Zyp #  5 , Matt Winkler #  4   8 , Alison Falconer #  4   8
Affiliations
Comparative Study

Conventional radical versus focal treatment for localised prostate cancer: a propensity score weighted comparison of 6-year tumour control

Marieke J van Son et al. Prostate Cancer Prostatic Dis. 2021 Dec.

Abstract

Background: For localised prostate cancer, focal therapy offers an organ-sparing alternative to radical treatments (radiotherapy or prostatectomy). Currently, there is no randomised comparative effectiveness data evaluating cancer control of both strategies.

Methods: Following the eligibility criteria PSA < 20 ng/mL, Gleason score ≤ 7 and T-stage ≤ T2c, we included 830 radical (440 radiotherapy, 390 prostatectomy) and 530 focal therapy (cryotherapy, high-intensity focused ultrasound or high-dose-rate brachytherapy) patients treated between 2005 and 2018 from multicentre registries in the Netherlands and the UK. A propensity score weighted (PSW) analysis was performed to compare failure-free survival (FFS), with failure defined as salvage treatment, metastatic disease, systemic treatment (androgen deprivation therapy or chemotherapy), or progression to watchful waiting. The secondary outcome was overall survival (OS). Median (IQR) follow-up in each cohort was 55 (28-83) and 62 (42-83) months, respectively.

Results: At baseline, radical patients had higher PSA (10.3 versus 7.9) and higher-grade disease (31% ISUP 3 versus 11%) compared to focal patients. After PSW, all covariates were balanced (SMD < 0.1). 6-year weighted FFS was higher after radical therapy (80.3%, 95% CI 73.9-87.3) than after focal therapy (72.8%, 95% CI 66.8-79.8) although not statistically significant (p = 0.1). 6-year weighted OS was significantly lower after radical therapy (93.4%, 95% CI 90.1-95.2 versus 97.5%, 95% CI 94-99.9; p = 0.02). When compared in a three-way analysis, focal and LRP patients had a higher risk of treatment failure than EBRT patients (p < 0.001), but EBRT patients had a higher risk of mortality than focal patients (p = 0.008).

Conclusions: Within the limitations of a cohort-based analysis in which residual confounders are likely to exist, we found no clinically relevant difference in cancer control conferred by focal therapy compared to radical therapy at 6 years.

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References

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