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Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study



Focal therapy (FT) ablates areas of prostate cancer rather than treating the whole gland. We compared oncological outcomes of FT to radical prostatectomy (RP).


Using prospective multicentre databases of 761 FT and 572 RP cases (November/2005-September/2018), patients with PSA < 20 ng/ml, Gleason </= 4 + 3 and stage </= T2c were 1–1 propensity score-matched for treatment year, age, PSA, Gleason, T-stage, cancer core length and use of neoadjuvant hormones. FT included 1–2 sessions. Primary outcome was failure-free survival (FFS) defined by need for salvage local or systemic therapy or metastases. Differences in FFS were determined using Kaplan–Meier analysis with log-rank test.


335 radical prostatectomy and 501 focal therapy patients were eligible for matching. For focal therapy, 420 had HIFU and 81 cryotherapy. Cryotherapy was used predominantly for anterior cancer. After matching, 246 RP and 246 FT cases were identified. For radical prostatectomy, mean (SD) age was 63.4 (5.6) years, median (IQR) PSA 7.9 g/ml (6–10) and median (IQR) follow-up 64 (30–89) months. For focal therapy, these were 63.3 (6.9) years, 7.9 ng/ml (5.5–10.6) and 49 [34–67] months, respectively. At 3, 5 and 8 years, FFS (95%CI) was 86% (81–91%), 82% (77–88%) and 79% (73–86%) for radical prostatectomy compared to 91% (87–95%), 86% (81–92%) and 83% (76–90%) following focal therapy (p = 0.12).


In patients with non-metastatic low- intermediate prostate cancer, oncological outcomes over 8 years were similar between focal therapy and radical prostatectomy.

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Fig. 1: Flow diagram and matching variables used for cohort development for the primary outcome.
Fig. 2: Primary outcome (definition 1): Kaplan–Meier curve reporting failure free survival against time for laparoscopic radical prostatectomy and focal therapy, after 1–1 matching and single imputation.
Fig. 3: Flow diagram demonstrating matching variables and cohort development for the secondary outcome.
Fig. 4: Secondary outcome (definition 2): Kaplan–Meier curve for failure free survival in 1–1 matched patients after single imputation.

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Sonacare and support the HIFU UK national registry (called HEAT) through an unrestricted grant. Galil/BTG Ltd previously supported the cryotherapy UK registry (called ICE, previously known as EuCAP) through unrestricted grants. None of the funding sources had any role or input into the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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Authors and Affiliations



TS and DR were responsible for data collection, analysis of the data. TS, DR and MP were responsible for production of the first draught and completed the data analysis. All authors were involved in data collection, manuscript preparation/draughting and approval of the final draught. HUA and MW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HUA and MW are guarantors of the study.

Corresponding author

Correspondence to Taimur T. Shah.

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Conflict of interest

HUA’s research is supported by core funding from the United Kingdom’s National Institute of Health Research (NIHR) Imperial Biomedical Research Centre. HUA currently receives funding from the Wellcome Trust, Medical Research Council (UK), Cancer Research UK, Prostate Cancer UK, The Urology Foundation, BMA Foundation, Imperial Health Charity, NIHR Imperial BRC, Sonacare Inc., Trod Medical and Sophiris Biocorp for trials in prostate cancer. HUA was a paid medical consultant for Sophiris Biocorp in the previous 3 years. ME’s research is supported by core funding from the United Kingdom’s National Institute of Health Research (NIHR) UCLH/UCL Biomedical Research Centre. He was awarded NIHR Senior Investigator in 2015. ME receives funding from NIHR-i4i, MRC (UK), Cancer Research UK, Sonacare Inc., Trod Medical, Cancer Vaccine Institute and Sophiris Biocorp for trials in prostate cancer. ME is a medical consultant to Sonacare Inc., Sophiris Biocorp, Steba Biotech, Exact Imaging and Profound Medical. CMM receives funding from the National Institute for Health Research, The European Association of Urology Research Foundation, MRC, Cancer Research UK, Prostate Cancer UK, Movember and the Cancer Vaccine Institute, for clinical prostate cancer research. She has received advisory board fees for Genomic Health. TTS receives funding from Prostate Cancer UK and the St Peters Trust for clinical research and has received funding for conference attendance from Astellis, Ferring and Galil Medical. HUA, ME, RH, CMM and MA are all proctors for HIFU and are paid for training other surgeons in this procedure. HUA and MA are proctors for cryotherapy and are paid for training other surgeons in this procedure. ME is a proctor for Irreversible Electroporation (Nanoknife) and is paid for training other surgeons in this procedure. HUA and RH are paid proctors for Rezum for the treatment of benign prostate hyperplasia. MW receives a travel grant and a loan of device from Zicom Biobot. DR is funded by a research grant from Prostate Cancer UK and receives travel grants from Imperial Health Charity. EE receives funding from the Urology Foundation, the BMA Foundation for Medical Research, Imperial Health Charity and the Royal College of Surgeons of England. None of the other authors have anything to declare.

Ethics approval and consent to participate

Prospective data collection was approved locally by Imperial College Healthcare NHS Trust Research and Development department for service and quality assurance, therefore the requirement of informed consent of patients was waived. The study was performed in accordance with the declaration of Helsinki.

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Shah, T.T., Reddy, D., Peters, M. et al. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched study. Prostate Cancer Prostatic Dis 24, 567–574 (2021).

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