Cryoablation as Prostate Cancer treatment
Cryoablation is a safe, minimally-invasive procedure that uses cold temperatures delivered via probes through the skin to kill prostate cancer (PCa) cells. Whole-gland cryoablation may offer an alternative treatment option to surgery and radiotherapy. Patients had good cancer outcomes 5 yr after whole-gland cryoablation, and those with a prostate-specific antigen value >0.2 ng/ml within 6 mo after treatment were more likely to have PCa recurrence.
Were retrospectively evaluated complications and functional and oncologic outcomes of 94 consecutive men who underwent primary whole-gland cryoablation for localized prostate cancer (PCa) from 2002 to 2012.
In total, 75% patients had D'Amico intermediate- (48%) or high- (27%) risk PCa.
Median follow-up was 5.6 yr. Median time to prostate-specific antigen (PSA) nadir was 3.3 mo, and 70 patients reached PSA <0.2 ng/ml postcryoablation.
The 90-d high-grade (Clavien Grade IIIa) compli- cation rate was 3%, with no rectal fistulas reported. Continence and potency rates were 96% and 11%, respectively.
The 5-yr biochemical failure-free survival (PSA nadir + 2 ng/ml) was 81% overall and 89% for low-, 78% for intermediate-, and 80% for high-risk PCa (p = 0.46).
The 5-yr clinical recurrence-free survival was 83% overall and 94% for low-, 84% for intermediate-, and 69% for high-risk PCa (p = 0.046).
Failure to reach PSA nadir <0.2 ng/ml within 6 mo postcryoablation was an independent predictor for biochemical failure (p = 0.006) and clinical recurrence (p = 0.03).
The 5-yr metastases-free survival was 95%.
Main limitation is retrospective evaluation.
Primary whole-gland cryoa- blation for PCa provides acceptable medium-term oncologic outcomes and could be an alternative for radiation therapy or radical prostatectomy.
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.