This NIHR HTA-funded project sought to determine the clinical benefits and cost-effectiveness of ablative therapy for men with localised prostate cancer. Ablative treatments considered were: brachytherapy; cryotherapy; high intensity focused-ultrasound (HIFU); vascular-targeted photodynamic therapy (PDT); transperineal radiofrequency interstitial tumour ablation (RITA) therapy; and laser ablation therapy. Traditional treatment options included surgical removal of the prostate; radical prostatectomy (RP), use of external beam radiotherapy (EBRT) to destroy the cancer, or active surveillance.
For primary ablative therapy, neither cryotherapy nor HIFU had sufficiently robust data to enable any definitive conclusions to be made. The effectiveness data on brachytherapy was more robust and there was some evidence that cancer-specific outcomes in the short-term were either better or equivalent to either EBRT or RP, with comparable adverse effect profiles apart from a possible increased risk of dysuria and urinary retention. The findings on focal ablative therapy were mostly derived from data on focal cryotherapy, which suggested that cancer-specific outcomes were at least comparable to full-gland cryotherapy, and there was a suggestion that urinary incontinence outcome may be better following focal cryotherapy compared with whole gland cryotherapy. In terms of the cost benefit analysis, the findings suggest that of all the ablative interventions, HIFU is the most likely to be considered cost-effective when assessed against threshold values for a cost per QALY that society might be willing to pay. However, there were considerable uncertainties within the analyses.
For salvage ablative therapy following primary EBRT, lack of reliable and robust data prevented any meaningful conclusions to be made, in comparison with salvage RP.
Overall, the findings of this assessment indicate that there is insufficient evidence to help inform recommendations on the use of ablative therapies in the UK NHS and that further research is needed.
For further details see: http://www.nets.nihr.ac.uk/projects/hta/1013601.
Craig Ramsay: firstname.lastname@example.org