Presented by: David Margel MD,PhD,MBA
Raphael Hospital, Israel

Introduction

Focal treatment for prostate cancer by ablative energies is an innovative approach to treatment. Our goal was to examine the oncological and functional results of focal treatments and test predictors of its success.

Materials

748 patients with low- or intermediate-risk prostate cancer were treated by focal therapy between May 2014-May 2023. The technologies we used were HIFU, nanoknife and cryotherapy. Oncologic follow-up protocol included PSA once every 3-6 months, annual MRI and fusion- biopsy if necessary. Functional outcome was assessed prospectively using questionnaires for sexual function (IIEF), leakage and LUTS (IPSS).

Results

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Median Patients' age was 68 years (IQR 64-72). 262 patients (35%) had low-risk prostate cancer (GG1 but tumor volume greater than 6 mm on biopsy or tumor volume greater than 1 cm on MRI) and 486 patients (65%) had intermediate-risk prostate cancer (GG2 and GG3). 246 patients were treated with HIFU, 28 with nanoknife and 474 with cryotherapy.

Oncologic Outcomes- At a median follow-up of 38.3 months, the median PSA decreased by 63% (IQR 48.3%-82.1%) MRI and normal PSA dynamics were observed in 561 (74%). Follow-up biopsy showed recurrence in the ablation area in 51 patients (6.8%), and recurrence outside the ablation area was diagnosed in 96 (13%). 80% of the patients (n=601) without evidence of active disease, 10% (n=72) underwent additional focal treatment, 5% needed treatment for the entire prostate (17 underwent surgery and 21 radiation).

Functional outcome - Mild urinary leakage was observed in 2 patients (0.004%). Baseline IPSS  ((9, IQR 4-16) improved (7, IQR 3-12). Overall, baseline IIEF (19, IQR 14-23) decreased by 16%. However, 12 months post-treatment 78% returned to base-line sexual function.

On multivariable Cox regression, Independent predictors for disease recurrence, were Grade Group (HR 1.5 9.5%CI 1.2-2.1) and tumor location (HR 0.8 9.5%CI 0.82-0.95)

Conclusion

At a median follow-up of over 3 years, focal treatments in low- or intermediate-risk prostate cancer patients demonstrate oncological successes while maintaining a good quality of life.

Funding

None

Co-Authors

Yaara Ber, PhD
Raphael Hospital