Does the CoreTherm®Concept Offering Transurethral Microwave Temperature Feedback Thermotherapy or Transurethral Resection of Prostate for Benign Obstruction have an Impact on Long-term Risk for Prostate Cancer Incidence and Mortality? Results from a Long time Nationwide Observational Cohort Investigation
Fredrik Stenmark Daniel Altman Björn Zackrisson Jan-Erik Damber Anders Bjartell Caroline Elmér Sonny SchelinAbstract :
ABSTRACT
Background and Hypothesis: Intraprostatic hyperthermia <45° beyond ablation necrosis at ≥45° during CoreThermR Concept (CT) treatment, a further developed TUMT, for benign prostate hyperplasia (BPH) may influence prostate cancer-related occurrence and death later in life.
Objective: To assess the risk of prostate cancer morbidity and mortality in men with BPH following thermotherapy/hyperthermia and transurethral resection of the prostate (TURP).
Design, Setting, and Participants: A nationwide, population-based study 1999-2019 in Sweden based on the Patient Register to identify cases of CT treatments (n= 4,686) and TURP (n= 74,527). Incident cases of prostate cancer were identified by linkage to the National Cancer Register.
Outcome Measurements and Statistical Analysis: Prostate cancer diagnosis and cancer-related mortality were the main outcome measures. Risks were calculated using hazard ratios (HRs) with a 95% Confidence interval (CI).
Results and Limitations: CT did not decrease the overall risk of being diagnosed with prostate cancer compared to TURP (HR 0.91, CI 0.79-1.04). For men above median age (71 years), CT decreased the risk for prostate cancer overall (HR 0.77, CI 0.64–0.92) and prostate cancer-specific death in the short-term (HR 0.51, 95% CI 0.32-0.83), long-term (HR 0.48, 95% CI 0.26-0.90) and overall (HR 0.66, 95% CI 0.49-0.87) compared to TURP. Age at intervention, age at diagnosis, and age at prostatecancer-related death did not differ significantly between the treatment groups overall.
Conclusions: Among men treated after 71 years of age CT for BPH was associated with an overall lower risk for a prostatecancer diagnosis later in life and a significantly decreased risk for prostate cancer-related death compared to TURP.
Patient Summary: Among elderly men with BPH, CT shows a decreased risk for prostate cancer and related death, comparedto TURP in this national survey. However, a better definition of these retrospective cohorts is warranted before CT can becompared and adopted as a prevention strategy for prostate cancer.
KEYWORDS
Benign Prostatic Hyperplasia (BPH); Incidental Prostate Cancer; Prostate Cancer Incidence and Mortality; CoreTherm® Concept(TUMT); Transurethral Resection of the Prostate (TURP); National Long-Time Observational Register Study.
