Is vascular-targeted photodynamic therapy or active surveillance more effective in the treatment of low-risk prostate cancer?



This study examined if vascular-targeted photodynamic therapy (VTPT), or active surveillance is more effective in the treatment of low-risk prostate cancer. This study concluded that patients who received VTPT were less likely to require radical therapy compared to those who underwent active surveillance. 

Active surveillance is a standard of care in men with low-risk, early-stage prostate cancer. It does not involve active treatment. Instead, it uses periodic tests such as biopsy (tissue sample taken from the cancer site). Prostate-specific antigen (PSA – a protein elevated in the blood in the presence of cancer) levels are also monitored, for signs of cancer progression. 

Focal therapy is a form of non-invasive treatment. This is where the cancerous tissues are destroyed, with minimal damage to surrounding areas. VTPT is a form of focal therapy, where a drug is given through the vein to destroy and kill cancer cells. A special light activates the drug inside the tumor, killing the cancer cells. 

If the cancer progresses, radical therapy may be required. Radical therapy is more invasive and may result in more serious side effects. This may include radical prostatectomy (complete removal of the prostate gland), radiation therapy or cryotherapy (freezing) of the whole prostate gland. High intensity focused ultrasound may also be used as radical therapy. Prostate cancer is often graded based on how aggressive the cancer is (called the Gleason score). The higher the Gleason score, the more likely the cancer can grow and spread.

It is not known if VTPT or active surveillance is more effective in the treatment of low-risk prostate cancer. 

413 men with low-risk prostate cancer were included in this study. 207 patients received VTPT, and 206 patients underwent active surveillance. All patients had a prostate biopsy at one and at two years after starting treatment or surveillance. Patients were followed up for an average of 4 years. 

At two years, 7% of patients who received VTPT, and 32% of patients under surveillance required radical therapy. At three years 15% of patients who received VTPT and 44% of patients under surveillance required radical therapy. At four years 24% of patients who received VTPT, and 53% of patients under surveillance required radical therapy. 

Patients with VTPT were 58% less likely to experience progression of the cancer than those under surveillance. There was no sign of cancer at the end of study biopsy for 50% of patients who had VTPT, and 14% of patients who were under surveillance. Patients who had VTPT were also more likely to have a lower Gleason score, compared to those who were after surveillance. 

This study concluded that patients who received VTPT were less likely to require radical therapy, compared to those who underwent active surveillance. 

This is a small study. There was no information about patient satisfaction reported in this study. Further studies are required.