To reduce treatment-related side effects in low-risk
prostate cancer (PCa), both focal
therapy and deferred treatments, including active surveillance (AS) and watchful waiting (WW), are worth considering over radical
prostatectomy (RP). Therefore, this study aimed to compare long-term survival outcomes between focal
therapy and AS/WW. Data were obtained and analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with low-risk PCa who received focal
therapy or AS/WW from 2010 to 2016 were included. Focal
therapy included
cryotherapy and
laser ablation. Multivariate Cox proportional hazards models were used to compare overall mortality (OM) and
cancer-specific mortality (CSM) between AS/WW and focal
therapy, and propensity score matching (PSM) was performed to reduce the influence of bias and unmeasured confounders. A total of 19 292 patients with low-risk PCa were included in this study. In multivariate Cox proportional hazards model analysis, the risk of OM was higher in patients receiving focal
therapy than those receiving AS/WW (hazard ratio [HR] = 1.35, 95% confidence interval [CI]: 1.02-1.79, P = 0.037), whereas no significant difference was found in CSM (HR = 0.98, 95% CI: 0.23-4.11, P = 0.977). After PSM, the OM and CSM of focal
therapy and AS/WW showed no significant differences (HR = 1.26, 95% CI: 0.92-1.74, P = 0.149; and HR = 1.26, 95% CI: 0.24-6.51, P = 0.782, respectively). For patients with low-risk PCa, focal
therapy was no match for AS/WW in decreasing OM, suggesting that AS/WW could bring more overall survival benefits.