Presentation Authors: Taimur T. Shah, LONDON, United Kingdom, Max Peters, Utrecht, Netherlands, Deepika Reddy*, Daniel Ball, Annie Kim, London, United Kingdom, Enrique Gomez Gomez, Cordoba, Spain, Saiful Miah, David Eldred-Evans, Stephanie Guillaumier, Feargus Hosking-Jervis, LONDON, United Kingdom, Peter S.N. van Rossum, Utrecht, Netherlands, Tim Dudderidge, Southampton, United Kingdom, Richard Hindley, Basingstoke, United Kingdom, Stuart McCracken, Damian Greene, Sunderland , United Kingdom, Raj Nigam, Guildford, United Kingdom, Massimo Valerio, Lausanne, Switzerland, Suks Minhas, London, United Kingdom, Naveed Afzal, Dorchester, United Kingdom, Henry Lewi, Chelmsford, United Kingdom, Neil McCartan, Chris Ogden, London, United Kingdom, Raj Persad, Bristol, United Kingdom, Jaspal Virdi, Harlow, United Kingdom, Caroline Moore, Manit Arya, Mark Emberton, Hashim U. Ahmed, Mathias Winkler, London, United Kingdom
Introduction: Focal therapy (FT) has a low side-effect profile but there is uncertainty about its medium-long term cancer control compared to radical approaches. Both focal HIFU and focal cryotherapy are used in the UK based on cancer characteristics and location. We aimed to compare cancer control of FT with radical prostatectomy.
Methods: In line with NICE guidance, multicentre prospective cancer registries were used to review all consecutive men undergoing either focal HIFU (n=625) or cryotherapy (n=122) and laparoscopic radical prostatectomy (LRP) (n=571) between 2007-17. Within FT intervention up to 2 focal sessions were allowed.â€¨â€¨A propensity score was constructed with groups matched 1:1 (FT[HIFU or Cryo]:LRP) using nearest neighbour matching. Inclusion criteria were PSA < 20ng/ml, Gleason=/ < 7 and T-stage=/
Results: After inclusion/exclusion criteria, 420 HIFU, 81 Cryotherapy and 346 LRP men remained with matching leading to 183 men in each cohort. The group were well matched for median Age (64 years), PSA (8.0-8.1 ng/ml), MCCL (6 mm). Gleason Scores were 3+3 in 66 (36%) , 3+4 in 105 (57.4%) , 4+3 in 12 (6.6%) (FT) and 3+3 in 60 (32.8%), 3+4 in 107 (58.5%) and 4+3 in 16 (8.7%) (LRP).â€¨â€¨At all-time points, there was no significant difference in FFS (p=0.39). The 5-year actuarial FFS for FT was 88% [95%CI 82-94] and 85% [95%CI 80-92] for LRP [Figure 1].â€¨â€¨Limitations include the inability to remove all sources of bias and certain variables such as tumour volume were not collected in the databases, although MCCL as a surrogate marker of disease volume was used.
Conclusions: Medium-term cancer control with a Focal Therapy approach appears comparable to LRP, accounting for variation in location, size and risk of organ confined prostate cancer. Whilst long-term data, ideally from RCTs, are awaited these might be used to help counsel patients about treatment options.