Articles

Focal Cryotherapy for Clinically Unilateral, Low-Intermediate Risk Prostate Cancer in 73 Men with a Median Follow-Up of 3.7 Years

By: Duke Bahna b, Andre Luis de Castro Abreua, Inderbir S. Gilla, Andrew J. Hunga, Paul Silvermanb, Mitchell E. Grossa, Gary Lieskovskya and Osamu Ukimuraa lowast

Published online: 01 July 2012

Keywords: Prostatic neoplasms, Cryotherapy, Biopsy, Ultrasound, Prostate-specific antigen

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Abstract

Background

Evolution of cryotherapy for prostate cancer is likely to result in parenchyma-sparing modifications adjacent to the urethra and neurovascular bundle. Results of initial series of focal therapy to minimize cryosurgery-related morbidity without compromising oncologic control have been encouraging, but limited in short-term outcomes.

Objective

To retrospectively report (1) median 3.7-yr follow-up experience of primary focal cryotherapy for clinically unilateral prostate cancer with oncologic and functional outcomes, and (2) matched-pair analysis with contemporaneous patients undergoing radical prostatectomy (RP).

Design, setting, and participants

Over 8.5 yr (September 2002 to March 2011), focal cryoablation (defined as ablation of one lobe) was performed in 73 carefully selected patients with biopsy-proven, clinically unilateral, low-intermediate risk prostate cancer. All patients underwent transrectal ultrasound (TRUS) and Doppler-guided sextant and targeted biopsies at entry.

Outcome measurements and statistical analysis

Post-therapy follow-up included measuring prostate-specific antigen (PSA) level every 3–6 mo; TRUS biopsies at 6–12 mo and yearly, as indicated; and validated symptom questionnaires. Matched-pair analysis compared oncologic outcomes of focal cryotherapy and RP (matched for age, PSA, clinical stage, and biopsy Gleason score).

Results and limitations

Complete follow-up was available in 70 patients (median follow-up: 3.7 yr; range: 1–8.5 yr). No patient died or developed metastases. Precryotherapy mean PSA was 5.9 ng/ml and Gleason score was 6 (n=30) or 7 (n=43). Postcryotherapy mean PSA was 1.6 ng/ml (70% reduction compared to precryotherapy; p<0.001). Of 48 patients undergoing postcryotherapy biopsy, 36 (75%) had negative biopsies; positive biopsy for cancer (n=12) occurred in the untreated contralateral (n=11) or treated ipsilateral lobe (n=1). Complete continence (no pads) and potency sufficient for intercourse were documented in 100% and 86% of patients, respectively. Matched-pair comparison of focal cryotherapy and RP revealed similar oncologic outcome, defined as needing salvage treatment.

Conclusions

Primary focal cryoablation for low-intermediate risk unilateral cancer affords encouraging oncologic and functional outcomes over a median 3.7-yr follow-up. Close surveillance with follow-up whole-gland biopsies is mandatory.

Take Home Message

We present oncologic and functional outcomes after hemifocal cryotherapy for low- to intermediate-risk prostate cancer with median 3.7-yr follow-up. In the matched-pair cohort, oncologic outcomes after focal cryosurgery versus radical prostatectomy were similar in terms of need for salvage therapy.

Keywords: Prostatic neoplasms, Cryotherapy, Biopsy, Ultrasound, Prostate-specific antigen.

Footnotes

a Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

b Prostate Institute of America, Community Memorial Hospital, Ventura, CA, USA

lowast Corresponding author. Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave., Ste. 7416, Los Angeles, CA 90089, USA. Tel. +1 323 865 3700; Fax: +1 323 865 0120.