Jim Hu: The 1st comparative study of focal therapy vs radical prostatectomy
Jim Hu, Director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center, shared a post on X about a recent paper by him and colleagues published in European Urology Focus:
Authors: Alec Zhu, Mary Strasser, Timothy McClure, Sofia Gereta, Emily Cheng, Kshitij Pandit, Jim Hu.
“Delighted to share in print the 1st comparative study of focal therapy (Cryo n=75) vs radical prostatectomy (n=298) for GG2 and GG3.
Consort Diagram – Inclusion and Exclusion Criteria.
Focal therapy treatment failure (biopsy >GG1) vs RP PSA >0.1 at 24 mo (33% vs 11%; p < 0.001) and 48 mo (43% vs 14%; p < 0.001). Focal therapy at 4.6 times higher salvage therapy rates 95% CI (2.7–7.9). Median F/U for FT vs RP was 52 vs 45 months.
Of note, in our Original submission HR 7.8 95%CI 3.2-18.6 for treatment failure (defined as FT Bx positive vs RP PSA>0.1). Reviewers wanted treatment free = SALVAGE THERAPY FREE survival. We used biopsy positive as a trigger for re-treatment. Bx positive vs PSA recurrence below.
Fewer overall 30-day RP vs. FT complications: 15% vs 35% (p<0.01). However, no difference in severe RP vs. FT (Clavien >2) complications, 2.7% vs 1.3% (p=0.7).”
Some doctors and influencers shared Jim’s post, adding:
Matt Cooperberg, Professor of Urology, Epidemiology and Biostatistics at UCSF:
“Well done study on RP vs focal tx for GG2-3 Prostate Cancer. Probably a bit predictable…
I like the emerging notion that in many cases focal is an effective adjunct to AS for intermediate risk, not really an RP/RT alternative.”
Brian Chapin, Professor and Fellowship Director at MDACC:
“FT vs AS for GG2 would be ethical and reasonable. Hard to do unless you don’t offer FT outside a trial.”
Tyler Seibert, Radiation Oncologist at UC San Diego:
“Limiting new therapies to clinical trials only would solve so many problems. True for focal therapy and myriad other technologies (including several in radiation oncology).”
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