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Volume 24, Issue 5 (September 2022) 24, 494–499; 10.4103/aja2021113

The comparison of survival between active surveillance or watchful waiting and focal laser ablation in patients with low-risk prostate cancer

Jia-Kun Li1, Chi-Chen Zhang1, Shi Qiu1, Kun Jin1, Bo-Yu Cai1, Qi-Ming Yuan1, Xing-Yu Xiong1, Lian-Sha Tang2, Di Jin1, Xiang-Hong Zhou1, Yi-Ge Bao1, Lu Yang1, Qiang Wei1

1 Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu 610041, China
2 Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China

Correspondence: Dr. Q Wei (weiqiang163163@163.com) or Dr. L Yang (wycleflue@163.com)

Date of Submission 18-May-2021 Date of Acceptance 16-Nov-2021 Date of Web Publication 28-Jan-2022


Prostate cancer (PCa) is the second-most common cancer among men. Both active surveillance or watchful waiting (AS/WW) and focal laser ablation (FLA) can avoid the complications caused by radical treatment. How to make the choice between these options in clinical practice needs further study. Therefore, this study aims to compare and analyze their effects based on overall survival (OS) and cancer-specific survival (CSS) to obtain better long-term benefits. We included patients with low-risk PCa from the Surveillance Epidemiology and End Results database of 2010–2016. Multivariate Cox proportional hazard analyses were conducted for OS and CSS in the two groups. To eliminate bias, this study applied a series of sensitivity analyses. Moreover, Kaplan–Meier curves were plotted to obtain survival status. A total of 18 841 patients with low-risk PCa were included, with a median of 36-month follow-up. According to the multivariate Cox proportional hazard regression, the FLA group presented inferior survival benefits in OS than the AS/WW group (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.37–3.33, P < 0.05). After adjusting for confounders, the result persisted (HR: 1.69, 95% CI: 1.02–2.81, P < 0.05). According to the results of the sensitivity analysis, the inverse probability of the treatment weighing model indicated the same result in OS. In conclusion, AS/WW and FLA have the advantage of fewer side effects and the benefit of avoiding overtreatment compared with standard treatment. Our study suggested that AS/WW provides more survival benefits for patients with low-risk PCa. More relevant researches and data will be needed for further clarity.

Keywords: active surveillance; cancer-specific survival; focal laser ablation; low-risk prostate cancer; overall survival; watchful waiting

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