Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
J Urol. 2023 Jul;210(1):108-116. doi: 10.1097/JU.0000000000003443. Epub 2023 Apr 4.
In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment. We evaluated the role of focal therapy in patients 70 years and older as an alternative management modality.
A total of 649 patients across 11 UK sites receiving focal high-intensity focused ultrasound or cryotherapy between June 2006 and July 2020 reported within the UK-based HEAT (HIFU Evaluation and Assessment of Treatment) and ICE (International Cryotherapy Evaluation) registries were evaluated. Primary outcome was failure-free survival, defined by need for more than 1 focal reablation, progression to radical treatment, development of metastases, need for systemic treatment, or prostate cancer-specific death. This was compared to the failure-free survival in patients undergoing radical treatment via a propensity score weighted analysis.
Median age was 74 years (IQR: 72, 77) and median follow-up 24 months (IQR: 12, 41). Sixty percent had intermediate-risk disease and 35% high-risk disease. A total of 113 patients (17%) required further treatment. Sixteen had radical treatment and 44 required systemic treatment. Failure-free survival was 82% (95% CI: 76%-87%) at 5 years. Comparing patients who had radical therapy to those who had focal therapy, 5-year failure-free survival was 96% (95% CI: 93%-100%) and 82% (95% CI: 75%-91%) respectively ( < .001). Ninety-three percent of those in the radical treatment arm had received radiotherapy as their primary treatment with its associated use of androgen deprivation therapy, thereby leading to potential overestimation of treatment success in the radical treatment arm, especially given the similar metastases-free and overall survival rates seen.
We propose focal therapy to be an effective management option for the older or comorbid patient who is unsuitable for or not willing to undergo radical treatment.
对于不想接受观察等待的老年患者，局部治疗可能是更具侵袭性的根治性治疗的替代方法。我们评估了 70 岁及以上患者接受局部高强度聚焦超声或冷冻治疗的作用，作为替代治疗方法。
在 2006 年 6 月至 2020 年 7 月期间，英国 11 个地点接受局部高强度聚焦超声或冷冻治疗的 649 名患者（报告于英国的 HEAT（高强度聚焦超声评估和治疗）和 ICE（国际冷冻治疗评估）登记处）进行了评估。主要结局是无失败生存，定义为需要 1 次以上局部再消融、进展为根治性治疗、发生转移、需要全身治疗或前列腺癌特异性死亡。通过倾向评分加权分析，将其与接受根治性治疗患者的无失败生存进行比较。
中位年龄为 74 岁（IQR：72，77），中位随访时间为 24 个月（IQR：12，41）。60%的患者为中危疾病，35%的患者为高危疾病。共有 113 名患者（17%）需要进一步治疗。16 名患者接受了根治性治疗，44 名患者需要接受全身治疗。5 年无失败生存率为 82%（95%CI：76%-87%）。与接受根治性治疗的患者相比，接受局部治疗的患者 5 年无失败生存率分别为 96%（95%CI：93%-100%）和 82%（95%CI：75%-91%）（<0.001）。根治性治疗组 93%的患者接受了放射治疗作为主要治疗方法，并伴随使用雄激素剥夺治疗，因此，尤其是考虑到相似的无转移和总生存率，可能高估了根治性治疗组的治疗效果。
我们建议将局部治疗作为不适合或不愿意接受根治性治疗的老年或合并症患者的有效治疗选择。
