Multimodality focal therapy for prostate cancer: outcome of the à la carte approach in clinical practice

摘要

Our study reported the outcome of a multimodality focal therapy (FT) cohort for localized primary prostate cancer. In a prospective registry all patients underwent magnetic resonance imaging and biopsy (fusion targeted or template biopsy) before FT. Modalities included focal high-intensity focused ultrasound (HIFU), focal cryotherapy, or targeted microwave ablation (TMA). Postoperatively, prostate-specific antigen and functional outcome assessment with validated questionnaires were checked 3 monthly. Magnetic resonance imaging was performed at 1 week, 6 months, and 12 months. Elective prostate biopsy was performed between 6 and 12 months. A total of 102 patients underwent FT between 2019 and 2024. The cohort consisted of 44 (43.1%) patients for focal HIFU, 18 (17.6%) patients for focal cryotherapy, and 40 (39.2%) patients for TMA. D'Amico low-, intermediate-, and high-risk patients accounted for 31 (30.4%), 66 (64.7%), and 5 (4.9%) patients, respectively. Referring to tumor location, focal HIFU had 38 (86.4%) posterior tumors, focal cryotherapy had 12 (72.2%) anterior tumors, and TMA had 31 (77.5%) anterior tumors. Biopsy data were available for 63 patients (61.8%). Clinically significant recurrence (International Society of Urological Pathology grade group: ≥2) were found in 7 patients (11.1%). Subsequent salvage treatment included the following cases: robotic radical prostatectomy: 2, radiotherapy: 4, and second focal cryotherapy: 1. No deterioration in Expanded Prostate Cancer Index Composite score was observed across all domains before and after the treatment. Improvement in the Urinary Irritative/Obstructive domain was observed in focal cryotherapy (78.3 vs. 91.5, P = 0.011) and TMA (75.7 vs. 84.9, P = 0.019) at 12 months. Multimodality FT with à la carte approach provides versatility in ablative strategies and offers a reasonable functional and oncological outcome for low- to intermediate-risk prostate cancer.