Urologic oncology · 2026
Cancer-specific mortality in high-risk or very high-risk prostate cancer patients treated with focal therapy vs. radical prostatectomy.
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Quarta Leonardo, Petix Michele, Filzmayer Maximilian, Orlandi Filippo, Goyal Jordan A, Ferro Matteo, Chun Felix K H, Micali Salvatore, Shariat Shahrokh F, Barletta Francesco, Stabile Armando, Gandaglia Giorgio, Montorsi Francesco, Saad Fred, Briganti Alberto, Karakiewicz Pierre I
Аннотация
INTRODUCTION: Focal therapy (FT) in high-risk or very high-risk prostate cancer (CaP) is not guideline-recommended. However, it may be occasionally used, but its effect on cancer-specific mortality (CSM) relative to standard treatment options such as radical prostatectomy (RP) is unknown and was addressed in the present study.
METHODS: In the Surveillance, Epidemiology, and End Results (SEER) database (2010-2022), high-risk or very high-risk CaP patients according to the National Comprehensive Cancer Network (NCCN) guidelines, treated with either FT or RP, were identified. A multivariable logistic regression (MLR) model assessed the associations between sociodemographic characteristics and receipt of FT. Multivariable competing risks regression (CRR) models, after 1:1 propensity score matching (PSM), tested for CSM differences after adjustment for other cause mortality (OCM).
RESULTS: Overall, 20,192 high-risk or very high-risk CaP patients treated with FT or RP were identified. Of those, 416 (2.0%) underwent FT and 19,776 (98.0%) RP. In the MLR model, rural area of residence and unmarried status predicted a 2.4-fold (P < 0.001) and 1.8-fold (P < 0.001) higher likelihood of receiving FT, respectively. In PSM analysis, 416 FT patients could only be matched with one RP control from 19,776 RP patients. After 1:1 PSM, at 120 months of follow-up, CSM after RP was 9.2 vs. 16.0% after FT. The corresponding OCM rates were 19.5 after RP vs. 31.5% after FT. In multivariable CRR models adjusted for OCM, FT increased CSM in a 2.0-fold fashion (mHR: 1.98; 95% CI: 1.17-3.34; P = 0.011).
CONCLUSION: Despite lack of guidelines endorsement, occasional high-risk or very high-risk CaP patients may be treated with FT. Specifically, rural and unmarried patients with high-risk or very high-risk CaP are more likely to receive guideline-discordant FT. Such practice doubles the risk of CSM relative to RP, and its use should therefore be discouraged in this patient population.
METHODS: In the Surveillance, Epidemiology, and End Results (SEER) database (2010-2022), high-risk or very high-risk CaP patients according to the National Comprehensive Cancer Network (NCCN) guidelines, treated with either FT or RP, were identified. A multivariable logistic regression (MLR) model assessed the associations between sociodemographic characteristics and receipt of FT. Multivariable competing risks regression (CRR) models, after 1:1 propensity score matching (PSM), tested for CSM differences after adjustment for other cause mortality (OCM).
RESULTS: Overall, 20,192 high-risk or very high-risk CaP patients treated with FT or RP were identified. Of those, 416 (2.0%) underwent FT and 19,776 (98.0%) RP. In the MLR model, rural area of residence and unmarried status predicted a 2.4-fold (P < 0.001) and 1.8-fold (P < 0.001) higher likelihood of receiving FT, respectively. In PSM analysis, 416 FT patients could only be matched with one RP control from 19,776 RP patients. After 1:1 PSM, at 120 months of follow-up, CSM after RP was 9.2 vs. 16.0% after FT. The corresponding OCM rates were 19.5 after RP vs. 31.5% after FT. In multivariable CRR models adjusted for OCM, FT increased CSM in a 2.0-fold fashion (mHR: 1.98; 95% CI: 1.17-3.34; P = 0.011).
CONCLUSION: Despite lack of guidelines endorsement, occasional high-risk or very high-risk CaP patients may be treated with FT. Specifically, rural and unmarried patients with high-risk or very high-risk CaP are more likely to receive guideline-discordant FT. Such practice doubles the risk of CSM relative to RP, and its use should therefore be discouraged in this patient population.