Focal therapy an effective option for older, comorbid prostate cancer patients

Focal ablative therapy may be used as an alternative treatment for older or comorbid patients with prostate cancer who are not fit or willing to undergo radical treatment, suggests a study.

An evaluation was conducted in 649 patients (median age 74 years, median follow-up 24 months) across 11 UK sites who had received focal high-intensity ultrasound or cryotherapy between June 2006 and July 2020 within the UK-based HEAT (HIFU Evaluation and Assessment of Treatment) and ICE (International Cryotherapy Evaluation) registries.

Failure-free survival, the primary outcome, was defined by the need for more than one focal reablation, progression to radical treatment, development of metastases, need for systemic treatment, or prostate cancer-specific death. The authors compared this outcome with that in patients undergoing radical treatment through a propensity score weighted analysis.

Of the patients, 60 percent had intermediate-risk disease and 35 percent high-risk. One hundred thirteen (17 percent) patients needed further management, with 16 undergoing radical therapy and 44 requiring systemic treatment.

At 5 years, 82 percent (95 percent confidence interval [CI], 76‒87) of patients achieved failure-free survival. Comparing patients who underwent radical therapy to those who had focal therapy, 5-year failure-free survival was 96 percent (95 percent CI, 93‒100) and 82 percent (95 percent CI, 75‒91), respectively (p<0.001).

In the radical treatment arm, 93 percent had received radiotherapy as their primary treatment with its associated use of androgen deprivation therapy. This could, therefore, lead to potential overestimation of treatment success in this group, given the similar metastases-free and overall survival rates seen.

“In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment,” the authors said.