Conventional radical versus focal treatment for localised prostate cancer: a propensity score weighted comparison of 6-year tumour control
| Autor: | Marieke J, van Son, Max, Peters, Deepika, Reddy, Taimur T, Shah, Feargus, Hosking-Jervis, Stephen, Robinson, Jan J W, Lagendijk, Stephen, Mangar, Tim, Dudderidge, Stuart, McCracken, Richard G, Hindley, Amr, Emara, Raj, Nigam, Raj, Persad, Jaspal, Virdi, Henry, Lewi, Caroline, Moore, Clement, Orczyk, Mark, Emberton, Manit, Arya, Hashim U, Ahmed, Jochem R N, van der Voort van Zyp, Matt, Winkler, Alison, Falconer |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Prostatectomy Salvage Therapy Brachytherapy Prostatic Neoplasms Androgen Antagonists Antineoplastic Agents Middle Aged Prostate-Specific Antigen United Kingdom Survival Rate Cryotherapy Biomarkers Tumor Disease Progression High-Intensity Focused Ultrasound Ablation Humans Registries Neoplasm Grading Propensity Score Aged Neoplasm Staging Netherlands Retrospective Studies |
| Zdroj: | Prostate cancer and prostatic diseases. 24(4) |
| ISSN: | 1476-5608 |
| Popis: | For localised prostate cancer, focal therapy offers an organ-sparing alternative to radical treatments (radiotherapy or prostatectomy). Currently, there is no randomised comparative effectiveness data evaluating cancer control of both strategies.Following the eligibility criteria PSA 20 ng/mL, Gleason score ≤ 7 and T-stage ≤ T2c, we included 830 radical (440 radiotherapy, 390 prostatectomy) and 530 focal therapy (cryotherapy, high-intensity focused ultrasound or high-dose-rate brachytherapy) patients treated between 2005 and 2018 from multicentre registries in the Netherlands and the UK. A propensity score weighted (PSW) analysis was performed to compare failure-free survival (FFS), with failure defined as salvage treatment, metastatic disease, systemic treatment (androgen deprivation therapy or chemotherapy), or progression to watchful waiting. The secondary outcome was overall survival (OS). Median (IQR) follow-up in each cohort was 55 (28-83) and 62 (42-83) months, respectively.At baseline, radical patients had higher PSA (10.3 versus 7.9) and higher-grade disease (31% ISUP 3 versus 11%) compared to focal patients. After PSW, all covariates were balanced (SMD 0.1). 6-year weighted FFS was higher after radical therapy (80.3%, 95% CI 73.9-87.3) than after focal therapy (72.8%, 95% CI 66.8-79.8) although not statistically significant (p = 0.1). 6-year weighted OS was significantly lower after radical therapy (93.4%, 95% CI 90.1-95.2 versus 97.5%, 95% CI 94-99.9; p = 0.02). When compared in a three-way analysis, focal and LRP patients had a higher risk of treatment failure than EBRT patients (p 0.001), but EBRT patients had a higher risk of mortality than focal patients (p = 0.008).Within the limitations of a cohort-based analysis in which residual confounders are likely to exist, we found no clinically relevant difference in cancer control conferred by focal therapy compared to radical therapy at 6 years. |
| Databáze: | OpenAIRE |
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