Repeat Focal Therapy After Treatment Failure Improves Functional Outcome in Prostate Cancer

Repeat focal therapy is associated with a favorable safety profile and functional outcomes in patients with prostate cancer who have experienced treatment failure with initial cryoablation or high-intensity focused ultrasound (HIFU), according to a study presented at the 2022 American Urological Association Annual Meeting.

According to Nima Nassiri, MD, of UCLA Health, Los Angeles, CA, who presented the research findings, repeat focal therapy represents a valuable treatment strategy in select patients with prostate cancer whose disease fails to respond to initial cryoablation or HIFU. In their study, Dr. Nassiri and colleagues examined the complications and adverse events, functional outcomes, and short-term oncological outcomes following repeat focal therapy in the treatment of localized prostate cancer in patients who had previously undergone cryoablation of HIFU.

All patients in the study had localized prostate cancer that had been complicated by treatment failure using the prior treatment strategies. The cohort included patients with grade group 2 or greater prostate cancer on follow-up biopsy or with detectable disease recurrence. For the purposes of the study, the researchers investigated complications at the perioperative, 30-, and 90-day periods. Secondary endpoints of interest included monthly continence and erectile function as well as oncological outcomes at up to 1 year of follow-up.

Out of 183 patients included in the study, approximately 24% required repeat focal therapy following initial cryoablation (n=29) or HIFU (n=14). No class 3 or higher Clavien-Dindo complications were reported after repeat focal therapy at any of the evaluated timepoints.

All patients in the study were continent. There was no worsening of urinary symptoms according to the Internationalized Prostate Symptom Score. The researchers found that urinary bother improved by a mean of 0.33 points. In men who were sexually active, erectile function, as measured by the International Index of Erectile Function, decreased by a mean of 1.17 points. Approximately 43% of the 28 men who had at least 6 months’ worth of follow-up after retreatment had persistent disease.

Despite the benefits observed with repeat focal therapy in this small prostate cancer sample, the researchers indicated that longer follow-up is needed to further assess oncological efficacy of the approach.