Comparative Effectiveness of Radiotherapy versus Focal Laser Ablation in Patients with Low and Intermediate Risk Localized Prostate Cancer

Xianghong Zhou,Jiakun Li,Lu Yang,Xinyang Liao,Xiang Tu,Shi Qiu,Di Jin,Qiang Wei,Kun Jin,Xiaonan Zheng

doi:10.1038/s41598-020-65863-8

Abstract

At present, focal laser ablation (FLA) as a new PCa local treatment has attracted attention. We aim at comparing the survival outcomes between radiotherapy (RT) and FLA to reveal whether FLA can be used as an alternative to RT for patients with low and intermediate-risk localized PCa.We conducted analyses with data from the SEER database (2004–2015). Propensity score matching and instrumental variate (IV) were used to reduce the influence of bias and unmeasured confounders maximally.In the adjusted multivariate regression, FLA had lower overall survival (OS) benefits (HR = 1.49; 95%CI: 1.18–1.87; p < 0.001). After propensity score matching, RT still had better OS (HR = 1.50; 95%CI: 1.17–1.93; p = 0.001). The outcomes of IV-adjusted analysis showed FLA was significantly inferior to RT in OS (HR = 1.49; 95%CI: 1.18–1.87). In the subgroup analyses, for those with PSA < 4 ng/mL, FLA showed markedly worse OS and cancer-specific mortality (CSM) outcomes (OS HR = 1.89; 95%CI: 1.01–3.53; p = 0.0466 and CSM HR = 4.25; 95%CI: 1.04–17.43; p = 0.044).FLA is a promising focal therapy of PCa. But our research demonstrated RT still had an obvious advantage in survival benefits over FLA. Using FLA as an alternative treatment for RT requires careful consideration by clinicians.

Highlights

Other than Active surveillance (AS), Radiotherapy (RT) and Radical prostatectomy (RP) are the standard active treatments for patients with low-risk or intermediate-risk localized prostate cancer recommended by current clinical guidelines[4]
A total of 93,469 patients were included in the analysis, including 93,041 patients treated with radiation therapy and 428 patients treated with laser ablation
Comparing patients who were treated with laser ablation versus those undergone radiotherapy, patients treated with laser ablation were more likely to have older age (p < 0.001), lower PSA (p < 0.05), and lower GS (p < 0.05)

Summary

Introduction

Other than Active surveillance (AS), Radiotherapy (RT) and Radical prostatectomy (RP) are the standard active treatments for patients with low-risk or intermediate-risk localized prostate cancer recommended by current clinical guidelines[4]. A recent phase II clinical trial reported that FLA was associated with favorable short-term oncologic outcomes with no major urinary, sexual, or bowel side effects[8]. Another small-scale longitudinal outcome study for patients with localized PCa showed that FLA could achieve early oncologic control of localized PCa with few complications or adverse effects on quality of life[9]. Whether FLA can bring long-term survival benefits equivalent to conventional treatments like RT for patients is still unclear To circumvent these defects, we evaluated the overall survival and prostate cancer-specific mortality at long-term follow-up in the comparison of patients treated with FLA versus patients treated with RT

Methods

Results

Discussion

Conclusion