“It’s more of the same. Essentially there was about a 25% reduction in risk of conversion to radical treatment, and that benefit is maintained,” said Dr. Gill, professor and chair of urology at the University of Southern California, Los Angeles.
As expected, survival rates were similar at 4 years. In both groups, 99% were metastasis free, and cancer-specific survival was 100% in both. Overall survival was 98% in the VTP group, and 99% in the active surveillance group.
Currently, in very-low-risk patients, active surveillance is recommended and generally accepted. But many low-risk patients choose RT, putting them at risk for impotency and incontinence. “With this treatment, if you can maintain a 25% reduction in crossover treatment, then more men with low-risk prostate cancer are going to be spared radical treatment than if you were just doing active surveillance. And if you don’t get radical therapy, then your long-term quality of life is better,” said Dr. Gill.
VTP does lead to a small increase in risk of impotency and in incontinence in the short term, but patients tend to recover, and by 2 years, there is no significant difference between the groups.
Cryoablation and high-intensity focused ultrasound are also available. Those are effective, but they seem to have a higher profile of incontinence, impotency, and urethral injury, although they haven’t been directly compared to VTP, so comparing their side effect profiles “is literally comparing apples to oranges,” Dr. Gill said.