Primary whole-gland cryoablation for prostate cancer (PCa) offers acceptable medium-term oncologic outcomes and could be an alternative to radical prostatectomy or radiation therapy, investigators concluded.
In a study of 94 consecutive patients who underwent primary whole-gland cryoablation for localized PCa and had a median follow-up of 5.6 years, the 5-year biochemical failure-free survival rate was 81% overall and 89%, 78%, and 80% for those with low-, intermediate-, and high-risk PCa, respectively, a team led by Andre Luis de Castro Abreu, MD, of the Keck School of Medicine at the University of Southern California in Los Angeles, reported online ahead of print in European Urology.
The 5-year recurrence-free survival rate 83% overall, and 94%, 84%, and 69%, for patients with low-, intermediate-, and high-risk disease, respectively. The 5-year metastasis-free survival rate was 95%.
Failure to reach a PSA nadir below 0.2 ng/mL within 6 months after cryoablation independently predicted biochemical failure, defined as PSA nadir plus 2 ng/mL, the investigators reported. On multivariate analysis, failure to reach a PSA level below 0.2 ng/mL was associated with a significant 3.6-fold increased risk of biochemical failure and 2.8-fold increased risk of clinical recurrence, which the investigators defined as cancer on follow-up biopsy, any evidence of clinical recurrence (by physical examination or imaging), administration of any salvage treatment, or initiation of androgen deprivation therapy.
Study limitations include its retrospective nature and selection of patients by transrectal ultrasound (TRUS) imaging and biopsy instead of magnetic resonance imaging (MRI) and MRI/TRUS fusion biopsy, which could add accuracy to staging and potentially provide better outcomes, Dr Abreu and his team stated. “Similarly, MRI was not part of the follow-up protocol either, which may have identified recurrences earlier,” they noted. “Nevertheless, our data show that whole-gland prostate cryoablation is safe and provides acceptable median-term oncologic outcomes that are comparable to other treatment modalities.”
Oishi M, Gill IS, Ashrafi AN, et al. Primary whole-gland cryoablation for prostate cancer: biochemical failure and clinical recurrence at 5.6 years of follow-up. Eur Urol. 2018; published online ahead of print.