Cancer control following focal prostate cryoablation for unilateral prostate cancer.

Abstract

e15167 Background: Widespread use of PSA screening has resulted in earlier detection of prostate cancer, often in younger patients with small-volume, unilateral disease. Partial-gland cryoablation, sparing healthy tissue and the ipsilateral neurovascular bundle, is an attractive option for patients with unilateral cancer who wish to preserve erectile function and continence. We report our early cancer outcome data for focal prostate cryoablation. Methods: We performed a retrospective review from a single-institution IRB-approved cryotherapy database of over 900 patients. Inclusion criteria: unilateral prostate cancer treated with primary focal cryoablation. Exclusion criteria: prior or concurrent hormonal therapy. Disease-free survival at 3 and 5 years was calculated using the Kaplan-Meier method, and multivariate Cox regression models were performed to determine predictors of cancer outcome. Results: From 2002-2010, 102 men underwent primary focal cryoablation for prostate cancer. Mean age was 69.3 years (standard deviation [SD] 6.7 years); mean follow-up time 30.0 months (SD 24.2 months); mean pre-operative PSA 7.0 ng/mL (SD 5.5 ng/mL); and median Gleason score sum 6 (range 5-9). Overall mean post-treatment PSA nadir was 1.2 ng/mL (SD 1.3 ng/mL). Following treatment, 22 patients underwent transrectal ultrasound-guided (TRUS) biopsy for clinical suspicion of recurrent disease, and 10/22 (45%) had confirmed recurrent prostate cancer. No patients developed metastatic disease at any point during follow-up. On multivariate analysis, preoperative PSA level, preoperative Gleason score, number of positive biopsy cores, and total tumor length were all associated with disease recurrence. Conclusions: Early data show encouraging disease-free survival rates using follow-up TRUS biopsy results. Focal prostate cryoablation is a promising option for carefully selected patients, although further follow-up and long-term disease control will determine its role in prostate cancer treatment.