The Comparative Toxicity of Focal Ablation Versus Intensity Modulated Radiation Therapy for Prostate Cancer

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Focal ablative therapy (FT) offers a less toxic alternative to traditional radiation therapy for prostate cancer (PCa).
• Comparative studies between FT and intensity modulated radiation therapy (IMRT) for PCa are lacking.
• Understanding treatment-related toxicities is crucial for patient management and treatment selection.

Purpose of the Study:

• To compare the rates of gastrointestinal (GI) and genitourinary (GU) toxicity between FT and IMRT in older men with PCa.
• To evaluate the association between treatment modality and specific complications within 24 months post-treatment.
• To provide evidence for guiding treatment decisions in PCa management.

Main Methods:

• Retrospective analysis of the SEER-Medicare database (2010-2017) for PCa patients.
• Mahalanobis matching of IMRT patients (n=9928) to FT patients (n=800) based on clinical and demographic factors.
• Logistic regression models used to assess GI and GU complications at 6, 12, and 24 months post-treatment.

Main Results:

• FT patients experienced significantly less GI toxicity (e.g., rectal bleeding, colitis) at 12 and 24 months compared to IMRT patients.
• FT was associated with a higher incidence of GU toxicity, including incontinence and erectile dysfunction, compared to IMRT.
• While IMRT showed more GI issues, related procedures were infrequent and not statistically different between groups.

Conclusions:

• Focal ablative therapy (FT) is linked to increased risks of incontinence and impotence in older men with prostate cancer compared to IMRT.
• Intensity modulated radiation therapy (IMRT) is associated with higher rates of GI toxicity, such as colitis and rectal bleeding.
• Treatment choice involves balancing GI and GU toxicity profiles for optimal patient outcomes in prostate cancer care.