Novel evaluation of clinical outcomes of focal therapy with high-intensity focused ultrasound for the patients with localized prostate cancer using win ratio analysis: A propensity score matched comparison of robot-assisted radical prostatectomy

Abstract

Abstract Background The objective of the present study was to compare the comprehensive clinical outcomes of focal therapy (FT) and robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer (PC) using a win ratio analysis. Methods Ninety patients who were treated with FT with high-intensity focused ultrasound and 254 patients who were treated with RARP for localized PC were evaluated. After propensity score matching, a win ratio analysis, in which the composite endpoints of failure-free survival (FFS) and the urinary domain of the Expanded Prostate Cancer Index Composite (EPIC) were analyzed, was used for the comparison of the clinical outcomes of FT and RARP for localized PC. Results Seventy-two patients were included in each group after propensity score matching. FFS was not significantly different between the groups (p = 0.5044) after 36 months of follow-up. In contrast, the score of the urinary domain of the EPIC in the FT group was significantly better than that in the RARP group (p < 0.0001). The win ratio of FT per RARP was 3.39 (p < 0.0001; 95% confidence interval: 2.21–5.20), suggesting a higher comprehensive outcome in the FT group than in the RARP group. Conclusions The win ratio analysis showed the superiority of comprehensive outcomes of FT to RARP for selected patients with localized PC during short-term follow-up in single institution. Although further randomized trial with long-term follow-up would be needed for the evaluation, the win ratio would be useful to analyze the efficacy of FT according to patient preferences comprehensively.