Vascular-targeted Photodynamic Therapy in Unilateral Low-risk Prostate Cancer in Germany: 2-yr Single-centre Experience in a Real-world Setting Compared with Radical Prostatectomy

Background: Vascular-targeted photodynamic therapy (VTP) is an approved treatment option for unilateral low-risk prostate cancer (PCa). Objective: Herein, we report our initial experience of patients treated by VTP. We compared short-term functional and oncological outcomes with those of a consecutive cohort of patients undergoing radical prostatectomy (RP) for unilateral low-risk PCa. Design, setting, and participants: Patients with unilateral low-risk PCa undergoing VTP (n = 41) and RP (n = 49) were evaluated in a real-world setting. Outcome measurements and statistical analysis: Oncological outcome after VTP was measured by magnetic resonance imaging-based rebiopsy at 12 and 24 mo. Functional outcome after 1 yr was investigated by International Index of Erectile Function 5 and International Prostate Symptom Score questionnaires. Continence was evaluated by pad use. Results and limitations: In 12-and 24-mo control biopsy (n = 22) after VTP, 45% of VTP patients showed no evidence of PCa. Both low-and intermediate-risk PCa were detected in 27% of patients. None of the RP patients had a PCa recurrence. Of VTP and RP patients, 71% and 30%, respectively, preserved erectile function. Of VTP patients, 88% had no bladder outlet obstruction. Of RP patients, 96% and 4% used zero to one and two or more pads per day, respectively. Data acquisition was performed outside of a clinical trial. The short-term follow-up and the small number of rebiopsied patients have to be considered. Conclusions: VTP is a promising treatment option in unilateral low-risk PCa presenting a lower complication profile than RP in a real-world setting. However, recurrence and progression after VTP are common in this low-risk PCa cohort, and have to be discussed critically with patients who wish VTP instead of active surveillance. Therefore, a rigorous surveillance strategy with multiparametric magnetic resonance imaging and control biopsy is required. Patient summary: Vascular-targeted photodynamic therapy (VTP) is a promising ther-apy option in patients with unilateral low-risk prostate cancer. However, tumour recurrence has to be taken into account. Noninferiority of VTP to standard curative treatment options still has to be confirmed. (c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Automated summary

This study presents the initial experience of treating patients with unilateral low-risk prostate cancer using vascular-targeted photodynamic therapy (VTP). The short-term functional and oncological outcomes of VTP were compared to those of patients undergoing radical prostatectomy (RP). The results showed that VTP had promising outcomes with lower complication rates compared to RP in a real-world setting. However, the recurrence and progression after VTP still need to be carefully discussed with patients who choose this treatment option.