24 November 2023
Minimally invasive focal therapies for prostate cancer such as cryoablation and high-intensity focused ultrasound (HIFU) are associated with a lower overall cost and improved quality of life compared to surgery or radiotherapy, according to a new study published in the Journal of Medical Economics.1
By using cryotherapy to freeze only the areas of cancer in the prostate, the normal tissue of the prostate is left intact. This leads to less collateral tissue damage to surrounding nerves, blood vessels, and muscles. HIFU uses high frequency sound waves to destroy prostate cancer cells2. The study found that focal therapy has a five-to-ten-fold lower risk of urinary, sexual and bowel side-effects compared to prostatectomy surgery or radiotherapy. This is because prostatectomy and radiotherapy treat the whole prostate. Patients having focal therapy have shorter recovery times, less pain, and fewer complications and side-effects than with surgery or radiotherapy. Previous clinical studies have shown focal therapy to be safe and effective to treat prostate cancer.3,4
Despite the potential benefits, few patients in the UK are offered focal therapies fortherapies for prostate cancer because there are a limited number of hospitals that provide it (see Figure 1) as an alternative to surgically removing or irradiating all of the prostate gland. With low awareness levels as a treatment option amongst healthcare providers and cancer patients, this leaves cancer patients unable to make informed choices or having to travel to receive cryoablation in London, Sunderland, Wirral or Southampton.
The study is a collaborative project between Boston Scientific, JB Medical, and researchers at Imperial College London that analysed data from over 1,000 patients. It compared costs and outcomes following focal therapy as well as those having prostatectomy surgery or radiotherapy for up to 10 years after treatment (see Figure 2 and Figure 3). The study’s economic model showed that focal therapy is good value for money5 in the National Health Service (NHS) for treating patients whose prostate cancer hasn’t spread, while also offering the benefit of fewer sexual, urinary, and rectal side effects.
“The research findings are great news for patients and great news for the health care system,” said Xavier Bertrand, vice president of Peripheral Interventions for Boston Scientific in EMEA. “The UK government has explicitly recognised the importance of medtech in improving outcomes for patients 6. Equal access to this minimally invasive cancer treatment could help to resolve the current disparities in the UK for patients with prostate cancer.”
Focal therapy was associated in the study with greater quality-adjusted life year (QALY) gains at a lower overall cost than radical prostatectomy or external beam radiotherapy (EBRT). "I wholeheartedly welcome and fully align with the report's conclusions,” said Paul Sayer, former HIFU patient and founder of the charity Prost8 which focuses on helping patients understand minimally invasive treatment options for prostate cancer. “Cryotherapy is a viable primary treatment option for localised or non-metastatic prostate cancer, particularly in cases where active monitoring is deemed unsuitable.“
"Our study is the first to show that focal therapy, using either cryotherapy or high-intensity focused ultrasound to destroy prostate cancers, was associated with a lower overall cost and improved quality of life for patients compared to either surgery or radiotherapy,” said Professor Hashim Ahmed, chair of Urology at Imperial College London, and consultant urological surgeon at Imperial College Healthcare NHS Trust. “Most patients with prostate cancer currently have radical prostatectomy or radiotherapy that treats the whole prostate. Focal therapy represents good value for money in the NHS whilst at the same time lower side effects and improved quality of life compared traditional treatments. It could benefit about 10,000 patients who are diagnosed with prostate cancer in the UK each year."
1. Reddy, D. et al. (2023) ‘Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis’ in Journal of Medical Economics, 26:1, 1099-1107, DOI: 10.1080/13696998.2023.2251849]
2. Cancer Research UK, Available from: High intensity focused ultrasound (HIFU) for prostate cancer | Cancer Research UK
3. Shah TT, Peters M, Eldred-Evans D, et al. Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry. Eur Urol. 2019;76(1):98–105. doi: 10.1016/j.eururo.2018. 12.030.
4. As with any medical treatment, a physician can best describe which therapy and associated risks and benefits may be right for each patient.
5. Reddy, D. et al. (2023) ‘Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis’ in Journal of Medical Economics, 26:1, 1099-1107, DOI: 10.1080/13696998.2023.2251849]
6. Medical Technology Strategy. United Kingdom: Government Digital Service; 3 February 2023. Available from: Medical technology strategy - GOV.UK (www.gov.uk)