Target focal therapy in early prostate cancer: Initial single institution results

Abstract

15574 Background: Currently the potential for over- and under-treatment using radical and watchful waiting options respectively constitutes a challenge in the management of patients with early organ-confined prostate cancer. Target focal therapy (TFT) is emerging as an intermediary alternative option for such men. The goal is to provide ablative treatment with minimal impact on morbidity. Methods: As part of an IRB approved study protocol a total of 24 patients initially underwent a 3 dimensional transperineal mapping biopsy under TRUS guidance to confirm the extent of tumor burden and localize the cancer foci within the prostate. Only 12 men qualified to undergo target focal cryotherapy. The remaining patients did not qualify due to upgrading or downgrading of their stage and opted for other treatment options. Follow- up consisted of serial PSA measurements at 3 months interval, disease specific QOL questionnaires, IPSS, and SHIM scores. Results: The mean age was 62.4 years. The mean (SD) prostate size at the time of mapping biopsy was 39 ±14.8g. After mapping biopsy all patients reported time limited hematuria and 2 patients developed urinary retention and were managed successfully with Foley’s catheter for 5 days. Mean PSA before treatment was 5.2 ± 4.1 ng/dl. 10/12 patients had Gleason score (GS) of 3+3, the remaining 2 patients had GS of 3+4. At 3 months follow-up. A median drop of PSA of 1.9 (0, 9.5) ng/dl. All patients reported full urinary continence post operatively. IPSS median drop of 0 (2, -16). Sexual health as assessed by SHIM score showed a median drop of 6 (1, -15) points. In general 4 patients reported a significant change in sexual performance. 2 of which opted for PDE inhibitor with successful regaining of erection at 6 months follow-up. Overall EPIC QOL scores showed no change in rectal, urinary and hormonal components. Sexual component registered a drop of 5 points. Conclusions: The current initial early results appear to be encouraging for future implementation of TFT on select patients with organ confined early stage cancer. Future larger randomized studies are needed to better understand the value of this alternative option in the management of prostate cancer. No significant financial relationships to disclose.