Habashy, David;
Reddy, Deepika;
Peters, Max;
Shah, Taimur T;
van Son, Marieke;
van Rossum, Peter;
Tanaka, Mariana Bertoncelli;
... Dudderidge, Tim; + view all
(2023)
Evaluation of Outcomes following Focal Ablative Therapy for Treatment of Localised Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-year Experience.
The Journal of Urology
10.1097/JU.0000000000003443.
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Abstract
PURPOSE: 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 (FT) in patients 70 years and older as an alternative management modality. MATERIALS AND METHODS: 649 patients across 11 UK sites receiving focal high intensity focused ultrasound (HIFU) or cryotherapy between June 2006 - July 2020 reported within the UK based HIFU Evaluation and Assessment of Treatment and the International Cryotherapy Evaluation (ICE) registries were evaluated. Primary outcome was failure free survival (FFS) defined by need for more than 1 focal re-ablation, progression onto radical treatment, development of metastases, need for systemic treatment or prostate cancer specific death. This was compared to the FFS in patients undergoing radical treatment via a propensity score weighted analysis. RESULTS: Median age was 74 years (IQR: 72, 77) and median follow-up 24 months (IQR: 12, 41). 60% had intermediate risk disease and 35% high risk disease. 113 patients (17%) required further treatment. 16 had radical treatment and 44 required systemic treatment. FFS was 82% (95% CI: 76-87%) at 5 years. Comparing patients who had radical therapy to those who had focal therapy, 5-year FFS was 96%, (95% CI: 93-100%) and 82% (95% CI: 75-91%) respectively, P < .001. 93% of those in the radical treatment arm had received Radiotherapy as their primary treatment with its associated use of Androgen Deprivation Therapy (ADT) thereby leading to potential over estimation of treatment success in the radical treatment arm, especially given the similar metastases free and overall survival rates seen. CONCLUSIONS: We propose FT to be an effective management option for the older or comorbid patient who is unsuitable for or not willing to undergo radical treatment.
| Type: | Article |
|---|---|
| Title: | Evaluation of Outcomes following Focal Ablative Therapy for Treatment of Localised Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-year Experience |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/JU.0000000000003443 |
| Publisher version: | https://doi.org/10.1097/JU.0000000000003443 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | ablation techniques, aged, cryotherapy, high-intensity focused ultrasound ablation, prostatic neoplasms |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10168193 |
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