PD17: Prostate Cancer: Localized: Ablative Therapy I
PD17-04: Is focal ablation as effective as hemi-ablation? Analysis of treatment patterns over 12 years from a high volume centre for focal therapy
Friday, May 15, 2020
7:00 AM – 9:00 AM
Armando Stabile, Nicola Fossati, Giorgio Gandaglia, Clement Orczyk, Francesco Giganti, Hashim U Ahmed, Simone Scuderi, Daniele Robesti, Vito Cucchiara, Giuseppe Fallara, Emanuele Zaffuto, Gabriele Sorce, Francesco Pellegrino, Vincenzo Mirone, Mark Emberton, Alberto Briganti, Francesco Montorsi, Caroline M Moore
Introduction: During introduction of an ablation service for localised prostate cancer, early protocols mandated a hemi-ablation approach. Later work tended towards an individualised focal treatment approach, using MRI tumour volume with an appropriate margin to plan treatment.
Methods: We identified 1032 men receiving FT for PCa between November 2005 and October 2017. The study outcome was to assess the trend over time of treatment planning (defined as focal- vs hemi-ablation) adjusting for patients characteristics. Multivariable logistic regression model (MVA) was developed to assess the relationship between treatment extension and year of treatment. Covariates were PSA, prostate volume, Gleason score (3+3 vs 3+4 vs =4+3), clinical stage (T1 vs T2 vs T3) and percentage of positive cores. The hypothesis that use of hemi-ablation differed by year of treatment was finally tested with a nonparametric loess analysis. Using the same analyses, retreatment probability of focal- vs hemi-ablation over time was tested and compared.
Results: 730 and 302 patients received a focal- and a hemi-ablation respectively. The median age was 65 yrs and median prostate-specific antigen was 7 ng/ml. The majority of patients had Gleason score of 3+4 (63%). Median follow-up was 36 months (IQR: 14-64). At MVA year of treatment was positively associated with use of focal-ablation over hemi-ablation (OR: 1.17; p<0.001). Figure 1 depicts the trend of focal-ablation according to year of treatment, after accounting for the confounders. The adjusted probability of receiving focal- vs hemi-ablation went from 34% to 87% from 2005 to 2017. Overall retreatment probability was decreasing over time and was comparable between focal- vs hemi-ablation (p=0.31).
Conclusions: Contemporary patients are more likely to receive a focal- over a hemi-ablation compared to the past. This has not resulted in a greater need for retreatment, suggesting that focal treatment based on MRI and biopsy results is as effective as routine hemi-ablation. Source of