Medium-term oncological outcomes of intermediate-risk prostate cancer treated with HIFU or cryotherapy. A single center 10-year experience
https://doi.org/10.4081/aiua.2022.4.413
Accepted: October 30, 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Objectives: Focal therapies (FTs) are promising techniques for the treatment of localized prostate cancer. We assessed the medium-term oncological outcomes of intermediate-risk prostate cancer (PCa) treated with HIFU or cryotherapy.
Materials and methods: One-hundred and fifty consecutive patients with intermediate-risk PCa, treated between 2009 and 2018 at a single center were included. Primary study outcome was failure-free survival (FFS), defined as absence of additional treatment, systemic progression or prostate cancer related death.
Results: Thirty-seven (25%) patients underwent cryotherapy and 113 (75%) HIFU. Median age was 69 (IQR 62-72) years, with 36 (24%) presenting palpable disease on rectal examination, and median total PSA of 7.85 (IQR 5.75-10.62) ng/mL. Patients were followed for a median of 61 (IQR 48-82) months. FFS at 2 and 4 years was of 75.6% and 53.6%, respectively. Survival from whole gland or systematic treatment at 2 and 4 years was of 78.9% and 53.9%, respectively. Patients with FFS presented lower total PSA nadir (1.89 vs 3.25 ng/mL, p < 0.001), higher % PSA reduction at 3 months (66.1% vs 49.3%, p < 0.001), and at nadir (75.5% vs 55.8%, p < 0.001). Other characteristics such has the treatment modality, age, prostate size, initial total PSA, cT stage, International Society of Urological Pathology (ISUP), tumor location and biopsy results by region did not differ between patients failing and not failing FT. Complications were uncommon (13%), with only onr (1%) patient having Clavien-Dindo grade > II. No deaths due to treatment were registered.
Conclusions: At medium-term, FTs for intermediate-risk PCa presented good oncological results, with an excellent safety profile.
Mottet N CP, vand den Bergh RCN, Briers E, Santis M, Gillessen S, et al. EAU EANM ESTRO ESUR ISUP SIOG Guidelines on Prostate Cancer. European Association of Urology 2022.
Lane JA, Donovan JL, Young GJ, Davis M, Walsh EI, Avery KNL, et al. Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study). BJU Int. 2022.
Lane JA, Donovan JL, Davis M, Walsh E, Dedman D, Down L, et al. Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncol. 2014;15(10):1109-18.
Lomas DJ, Ahmed HU. All change in the prostate cancer diagnostic pathway. Nat Rev Clin Oncol. 2020;17(6):372-81.
Kasivisvanathan V, Emberton M, Ahmed HU. Focal therapy for prostate cancer: rationale and treatment opportunities. Clin Oncol (R Coll Radiol). 2013;25(8):461-73.
Network NCC. NCCN Clinical Practice Guidelines in Oncology - Prostate Cancer. Version 1.2023.
Redondo C, Srougi V, da Costa JB, Baghdad M, Velilla G, Nunes-Silva I, et al. Focal cryotherapy: step by step technique description. Int Braz J Urol. 2017;43(5):995-6.
Claros OR, Tourinho-Barbosa RR, Carneiro A, Collura-Merlier S, Macek P, Lanz C, et al. HIFU focal therapy for prostate cancer using intraoperatory contrast enhanced ultrasound. Arch Esp Urol. 2019;72(8):825-30.
Gontero P, Marra G, Teber D, Shariat S, Albayrak S, Coelho R, et al. Making a case "against" focal therapy for intermediate-risk prostate cancer. World J Urol. 2021;39(3):719-28.
Wang AZ, Lebastchi AH, O'Connor LP, Ahdoot M, Mehralivand S, Yerram N, et al. Making a case "for" focal therapy of the prostate in intermediate risk prostate cancer: current perspective and ongoing trials. World J Urol. 2021;39(3):729-39.
McIntosh M, Opozda MJ, O'Callaghan M, Vincent AD, Galvao DA, Short CE. Why do men with prostate cancer discontinue active surveillance for definitive treatment? A mixed methods investigation. Psychooncology. 2022;31(8):1420-30.
Bokhorst LP, Valdagni R, Rannikko A, Kakehi Y, Pickles T, Bangma CH, et al. A Decade of Active Surveillance in the PRIAS Study: An Update and Evaluation of the Criteria Used to Recommend a Switch to Active Treatment. Eur Urol. 2016;70(6):954-60.
Shah TT, Reddy D, Peters M, Ball D, Kim NH, Gomez EG, et al. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study. Prostate Cancer Prostatic Dis. 2021;24(2):567-74.
Reddy D, Peters M, Shah TT, van Son M, Tanaka MB, Huber PM, et al. Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience. Eur Urol. 2022;81(4):407-13.
Stabile A, Orczyk C, Giganti F, Moschini M, Allen C, Punwani S, et al. The Role of Percentage of Prostate-specific Antigen Reduction After Focal Therapy Using High-intensity Focused Ultrasound for Primary Localised Prostate Cancer. Results from a Large Multi-institutional Series. Eur Urol. 2020;78(2):155-60.
Fujihara A, Ukimura O. Focal therapy of localized prostate cancer. Int J Urol. 2022.
Jain AL, Sidana A, Maruf M, Sugano D, Calio B, Wood BJ, et al. Analyzing the current practice patterns and views among urologists regarding focal therapy for prostate cancer. Urol Oncol. 2019;37(3):182 e1- e8.
Marra G, Ploussard G, Ost P, De Visschere PJL, Briganti A, Gandaglia G, et al. Focal therapy in localised prostate cancer: Real-world urological perspective explored in a cross-sectional European survey. Urol Oncol. 2018;36(12):529 e11- e22.
Hopstaken JS, Bomers JGR, Sedelaar MJP, Valerio M, Futterer JJ, Rovers MM. An Updated Systematic Review on Focal Therapy in Localized Prostate Cancer: What Has Changed over the Past 5 Years? Eur Urol. 2022;81(1):5-33.
Borkowetz A, Blana A, Bohmer D, Cash H, Ehrmann U, Franiel T, et al. German S3 Evidence-Based Guidelines on Focal Therapy in Localized Prostate Cancer: The First Evidence-Based Guidelines on Focal Therapy. Urol Int. 2022;106(5):431-9.
Tay KJ, Scheltema MJ, Ahmed HU, Barret E, Coleman JA, Dominguez-Escrig J, et al. Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project. Prostate Cancer Prostatic Dis. 2017;20(3):294-9.
Copyright (c) 2022 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
