Primary focal cryotherapy for low-intermediate risk unilateral prostate cancer (PCa) offers encouraging oncologic and functional outcomes after a median follow-up of 3.7 years, researchers reported.
Duke Bahn, MD, of the University of Southern California in Los Angeles, and colleagues studied 73 patients who underwent the treatment. All were carefully selected individuals with biopsy-proven, clinically unilateral low-intermediate risk PCa. All patients underwent transrectal ultrasound-guided and Doppler-guided sextant and targeted biopsies. Of the 73 patients, 70 had complete follow-up information (for one year or more) available. Three patients were lost to follow-up.
The cryotherapy patients were matched by age, PSA, clinical stage, and biopsy Gleason score to patients who underwent radical prostatectomy (RP).
The cryotherapy patients had a mean pre-treatment PSA level of 5.9 ng/mL.This dropped by 70% to 1.6 ng/mL after treatment. In addition, of 48 patients who underwent a post-treatment biopsy, 36 (75%) had negative findings, according to findings published online ahead of print in European Urology. Biopsies revealed cancer in the contralateral untreated lobes of 11 patients and the ipsilateral lobe of one patient.
Complete urinary continence (the need for no pads) and potency sufficient for intercourse were documented in 100% and 86% of subjects, respectively. Furthermore, the cryotherapy and RP patients had similar oncologic outcomes, defined as the need for salvage treatment.
The researchers observed that appropriate patient selection and standardized follow-up protocols remain controversial issues in PCa focal therapy. “In our opinion, image visibility of prostate cancer is important for enhancing patient selection for cancer control, since image mapping of cancer lesions allows precise therapeutic targeting by image guidance,” the authors wrote.