Focal Therapy for Prostate Cancer: A Treatment Option Reserved for the Ideal Candi-date?

Area of Science:

• Oncology
• Urology
• Medical Technology

Background:

• Focal therapy (FT) offers a less invasive treatment for prostate cancer (PCa).
• Traditional FT candidate selection excludes many patients, particularly those with intermediate-risk disease (ISUP 2).
• Evaluating outcomes for non-ideal FT candidates is crucial for expanding treatment accessibility.

Purpose of the Study:

• To assess the safety and efficacy of expanding focal therapy (FT) selection criteria in prostate cancer (PCa) patients.
• To evaluate outcomes in patients with ISUP 1 and ISUP 2 prostate cancer treated with FT, including those not meeting ideal criteria.
• To determine if broadening FT eligibility is safe and effective.

Main Methods:

• Retrospective analysis of 282 prostate cancer patients treated with FT (HIFU or cryotherapy).
• Patients were categorized into ideal candidates (G1), ISUP 1 with deviations (G2), and ISUP 2 with deviations (G3).
• Multivariable regression and propensity score matching were used to analyze recurrence-free survival.

Main Results:

• Overall recurrence rate was 66%, with no significant differences in recurrence-free survival between ideal candidates (G1) and ISUP 2 patients with deviations (G3).
• In ISUP 2 patients, lesion size ≥12mm was independently associated with worse infield recurrence-free survival (p=0.01).
• Expanding FT criteria to selected ISUP 2 patients demonstrated comparable outcomes to ideal candidates.

Conclusions:

• Expanding focal therapy selection criteria to include carefully selected ISUP 2 patients is potentially safe.
• Lesion size is a critical factor influencing recurrence-free survival in focal therapy for prostate cancer.
• Further multicenter studies are needed to validate these findings and refine selection criteria for focal therapy.