Focal therapy vs active surveillance in men with low-risk prostate cancer

The authors aimed to determine the safety and efficacy of focal therapy compared to active surveillance in men with low-risk prostate cancer.

The authors concluded that focal therapy was a safe and effective treatment option in men with low-risk prostate cancer. The also suggested that this treatment could be an option to avoid more radical treatments.

Active surveillance is a standard of care in men with low-risk, early-stage prostate cancer. It does not involve active treatment but instead uses tests such as biopsy (tissue sample taken from the cancer site) and prostate specific antigen (PSA – protein elevated in the blood in the presence of cancer) levels to monitor for signs of cancer progression. Focal therapy is a form of non-invasive treatment where the cancerous tissues are destroyed, with minimal damage to surrounding areas. Vascular-targeted photodynamic therapy is a form of focal therapy where a drug is giving through an IV to destroy and kill cancer cells. This is achieved using a special light which activates the drug inside the tumor, killing the cancer cells.

The aim of this study was to compare focal therapy to active surveillance in men with low-risk (confined to the prostate gland) cancer.

413 men were included in this study, with an average follow-up of 24 months. Patients were randomly assigned to one of two groups. Group 1 received focal therapy (206 men). Group 2 underwent active surveillance (207 men).

Men in group 1 had a longer time until cancer progression (28.3 months) compared to group 2 (14.1 months). The percentage of men with disease progression at month 24 was lower in group 1 (28%) compared to group 2 (58%). 49% of men in group 1 had a negative biopsy result at month 24 compared to 14% in group 2. Fewer men in group 1 underwent further treatments such as radiotherapy of prostate surgery compared to group 2.

In men who did not experience cancer growth, focal therapy was associated with a significant decrease at month 24 in all tumor burden measurements compared to active surveillance. The most common side-effects were retention of urine, inflammation of the prostate gland, and erectile dysfunction.

The authors concluded that focal therapy was a safe and effective treatment option in men with low-risk prostate cancer. They also suggested that this treatment could be an option to avoid more radical treatments.