Focal therapy for prostate cancer is cost-effective and may improve patient outcomes

Minimally invasive therapies for prostate cancer which remove the cancer while leaving the rest of the prostate intact are associated with lower costs for the NHS and benefits for patients.

These are the findings of a new study, published recently in the Journal of Medical Economics, and led by researchers from Imperial College Healthcare NHS Trust and Imperial College London.

The study shows that when compared to surgery or radiotherapy, these minimally invasive treatments, known as focal therapies, are associated with lower overall costs and improved quality of life. The research indicates that focal therapy represents good value for money in the NHS.

Focal therapies can include cryotherapy, which freezes the areas of cancer in the prostate, or high intensity focused ultrasound (HIFU), which heats the areas of cancer. Both treatments target only the cancer cells. This means less damage to surrounding nerves, blood vessels, and muscles and a lower risk of urinary, sexual and bowel side-effects compared to surgery to remove the prostate or radiotherapy.

Currently, few patients in the UK receive focal therapy for prostate cancer. The treatments are available at 7 centres in the country, including at Imperial College Healthcare NHS Trust.

In the latest study researchers analysed data from over 1,300 patients treated at five hospitals between 2006–2018, including Imperial College Healthcare. The team developed an economic model to compare costs and outcomes following focal therapy, surgery or radiotherapy for up to 10 years after treatment.

Focal therapy was associated with better outcomes in a questionnaire measuring quality of life than radical prostatectomy or external beam radiotherapy (EBRT).

Professor Hashim Ahmed, Chair of Urology at Imperial College London, and Consultant Urological Surgeon at Imperial College Healthcare NHS Trust, said: “Our study is the first to show that focal therapy, using either cryotherapy or high-intensity focused ultrasound (HIFU) to destroy prostate cancers, was associated with a lower overall cost and improved quality of life for patients compared to either surgery or radiotherapy.

“This is because focal therapy precisely targets individual cancers in the prostate leading to less tissue damage, quicker recovery and much fewer side-effects. The treatment is also effective at treating cancers. Most patients with prostate cancer currently have radical prostatectomy or radiotherapy which treat the whole prostate.”

The researchers highlight some limitations with the work, explaining the limited number of hospitals mean that other potential treatment options were excluded, and that limited data were available on later outcomes, and none on quality of life data, so literature-based estimates were used.

Professor Ahmed, added: "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 men who are diagnosed with prostate cancer in the UK each year.”

Xavier Bertrand, vice president of Peripheral Interventions for Boston Scientific in EMEA, who funded the study, said: “The research findings are great news for patients and great news for the healthcare system. The UK government has explicitly recognised the importance of medtech in improving outcomes for patients. Equal access to this minimally invasive cancer treatment could help to resolve the current disparities in the UK for patients with prostate cancer.” 

The work was also supported by the NIHR Imperial Biomedical Research Centre.

Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis’ by Reddy, D. et al. is published in Medical Economics.