Introduction

Prostate cancer (PCa) is the most commonly diagnosed non-cutaneous cancer in men. Focal therapy for prostate cancer may provide a “middle ground” between active surveillance (AS) and radical therapy. This treatment strategy is increasingly being offered to patients due to its ability to delay the need for radical treatment and metastasis while preserving urological function in the short and intermediate term. This study aims to assess patient experiences and regret following focal therapy.

Methods

The study was conducted under approved IRB HUM00275858. Patients were selected as male adults over age of 22 who underwent and completed focal treatment for a histological diagnosis of prostate cancer. Patients were contacted via telephone call and those who consented engaged in a survey that collected demographic information, Decision Regret scores, AUA Symptom Score (AUASS), and Sexual Health Inventory for Men (SHIM) scores.

Results

The median household income was $98,000 and the average out of pocket costs associated with treatment were approximately $1,500. The types of focal therapy treatment were cryotherapy (n=8), high intensity functional ultrasound (HIFU) (n=4), and nanoparticle (n=7). Average decisional regret was 1.54 out of 5, indicating very low decisional regret in respondents across focal therapies, with nanoparticle therapy having the highest decisional regret (1.91), then cryotherapy (1.75), then HIFU (1.6). A two tailed t-test indicated no significant difference in pre- versus post-treatment urinary symptoms (AUASS; t(36)=-1.26, p<0.05). In contrast, there was a statistically significant decline in erectile function (SHIM) scores following focal therapy (t(36)=2.52, p<0.05).

Conclusions

Preliminary findings from the focal therapy patient group reported low decisional regret, decreased erectile function and preserved urinary function following focal therapy treatment. A limitation of the study is low patient engagement with the survey, but future collection and analysis, including the additional perspectives of the radical prostatectomy cohort, will provide further insights to either support or challenge these findings. Further limitations of the study are patients not actively participating due to high levels of regret or shame due to urological symptoms or cancer control, as well as potential response bias from use of telephone surveying.