Primary whole gland cryoablation for prostate cancer (PCa) based on targeted biopsy-proven cancer mapping, achieves acceptable oncologic and functional outcomes at 5 years, investigators reported at the Society of Urologic Oncology 17th annual meeting in San Antonio, Texas.
Alfredo Maria Bove, MD, and colleagues at the University of Southern California in Los Angeles reviewed the records of 102 patients undergoing whole gland cryoablation for localized PCa. At entry, image-based cancer mapping using staging biopsy guided by transrectal ultrasound and Doppler were digitally documented. All procedures were performed under TRUS guidance with individualized cryoneedle delivery based on preoperative cancer mapping. The researchers defined biochemical failure as post-treatment PSA level above 0.2 ng/mL and a PSA nadir + 2 (the Phoenix definition).
The median follow-up was 5 years. Patients had a median age of 71 years and median PSA level of 7.5 ng/mL. The clinical stage was T1c in 48% of men, T2 in 44%, and T3 in 8%). The D’Amico group risk was low in 24% of men, intermediate in 50%, and high in 26%. In 65 patients (66%) PSA declined to below 0.2 ng/mL. The estimated biochemical failure-free survival (EBFFS) rate was 84% by the Phoenix definition. In addition, 73 biopsies were performed in 43 (44%) patients, with 5 (5%) positive for PCa.
Complications developed in 13 patients (12.7%). The incontinence rate was 4%. Potency recovered in 12% of patients.
The researchers compared the cryoablation cohort with 102 men who underwent open radical prostatectomy (RP), matching the patients by preoperative PSA level, Gleason score, and clinical stage. The 5-year EBFFS, based on patients who had a post-treatment PSA level above 0.2 ng/mL, was 39% for the cryoablation cohort and 79% for the RP cohort, a statistically significant difference between the groups. Metastases developed in 5 (5%) of the cryoablation patients and 4 (4%) of the RP patients. Eight cryotherapy and 12 RP patients required salvage treatment.
Dr Bove and colleagues concluded that cryoablation “for PCa using individualized cryoneedle delivery based on biopsy-proven cancer mapping achieved acceptable oncologic and functional outcomes with low rates of incontinence and complications. Regarding metastases and need for salvage treatment, cryoablation provided median 5-year oncologic outcomes comparable to that of pair-matched open RP.
1. Bove AM, Abreu AL, Chopra S, et al. Primary total gland cryoablation for prostate cancer. 5 years of oncologic and functional follow-up data prospectively collected and compared to radical prostatectomy. Poster presented at the Society of Urologic Oncology 17th annual meeting in San Antonio, Texas. Poster 124.