Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Prostate Cancer Prostatic Dis. 2021 Jun;24(2):567-574. doi: 10.1038/s41391-020-00315-y. Epub 2021 Jan 28.
Focal therapy (FT) ablates areas of prostate cancer rather than treating the whole gland. We compared oncological outcomes of FT to radical prostatectomy (RP).
Using prospective multicentre databases of 761 FT and 572 RP cases (November/2005-September/2018), patients with PSA < 20 ng/ml, Gleason </= 4 + 3 and stage </= T2c were 1-1 propensity score-matched for treatment year, age, PSA, Gleason, T-stage, cancer core length and use of neoadjuvant hormones. FT included 1-2 sessions. Primary outcome was failure-free survival (FFS) defined by need for salvage local or systemic therapy or metastases. Differences in FFS were determined using Kaplan-Meier analysis with log-rank test.
335 radical prostatectomy and 501 focal therapy patients were eligible for matching. For focal therapy, 420 had HIFU and 81 cryotherapy. Cryotherapy was used predominantly for anterior cancer. After matching, 246 RP and 246 FT cases were identified. For radical prostatectomy, mean (SD) age was 63.4 (5.6) years, median (IQR) PSA 7.9 g/ml (6-10) and median (IQR) follow-up 64 (30-89) months. For focal therapy, these were 63.3 (6.9) years, 7.9 ng/ml (5.5-10.6) and 49 [34-67] months, respectively. At 3, 5 and 8 years, FFS (95%CI) was 86% (81-91%), 82% (77-88%) and 79% (73-86%) for radical prostatectomy compared to 91% (87-95%), 86% (81-92%) and 83% (76-90%) following focal therapy (p = 0.12).
In patients with non-metastatic low- intermediate prostate cancer, oncological outcomes over 8 years were similar between focal therapy and radical prostatectomy.
局部治疗（FT）消融前列腺癌的部位而不是治疗整个腺体。我们比较了 FT 和根治性前列腺切除术（RP）的肿瘤学结果。
使用前瞻性多中心数据库的 761 例 FT 和 572 例 RP 病例（2005 年 11 月至 2018 年 9 月），PSA<20ng/ml、Gleason<4+3 和分期<2c 的患者，按治疗年份、年龄、PSA、Gleason、T 分期、癌症核心长度和新辅助激素使用进行 1:1 倾向评分匹配。FT 包括 1-2 次治疗。主要结局是无失败生存（FFS），定义为需要挽救性局部或全身治疗或转移。使用 Kaplan-Meier 分析和对数秩检验确定 FFS 差异。
335 例根治性前列腺切除术和 501 例局部治疗患者符合匹配条件。对于局部治疗，420 例采用 HIFU 治疗，81 例采用冷冻治疗。冷冻治疗主要用于前癌。匹配后，确定了 246 例 RP 和 246 例 FT 病例。对于根治性前列腺切除术，平均（SD）年龄为 63.4（5.6）岁，中位（IQR）PSA 为 7.9ng/ml（6-10），中位（IQR）随访时间为 64（30-89）个月。对于局部治疗，这些分别为 63.3（6.9）岁、7.9ng/ml（5.5-10.6）和 49[34-67]个月。在 3、5 和 8 年时，FFS（95%CI）为根治性前列腺切除术 86%（81-91%）、82%（77-88%）和 79%（73-86%），局部治疗为 91%（87-95%）、86%（81-92%）和 83%（76-90%）（p=0.12）。
在非转移性低中度前列腺癌患者中，8 年以上的肿瘤学结果在局部治疗和根治性前列腺切除术中相似。
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