Abstract
Purpose: To compare the oncologic outcomes of cryoablation (CA) and radical prostatectomy (RP) in patients with low- and intermediate-risk localized prostate cancer (PCa).Materials and Methods: PCa patients who received CA or RP between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable Cox proportional hazard analysis was used to compare the prostate cancer-specific survival (CSS) and overall survival (OS). We conducted 1:3 propensity score matching and adjusted standardized mortality ratio weighting (SMRW) to balance the clinicopathological characteristics.Results: Ninety-seven thousand seven hundred eighty-three patients were identified after preliminary screening. After matching, the CA and RP groups included 1,942 and 5,826 patients and had median follow-up periods of 85 and 72 months, respectively. CA had lower CSS and OS rates (hazard ratio [HR], 2.07; P = 0.007; HR, 2.09; P < 0.001, respectively) than did RP, which was consistent in the SMRW model (CSM: HR, 2.66; P < 0.001; OS: HR, 2.29; P < 0.001). The 10-years CSS and OS for CA vs. RP were 98.1 vs. 99.2% and 61.3 vs. 79.9%, respectively.Conclusions: In patients with low- to intermediate-risk localized PCa, CA had lower CSS rates than did RP. However, the high 10-years CSS rates indicated that CA could be an option for those who are not RP candidates. Further high-quality trials are needed to confirm and expand our findings.
Highlights
The screening strategies of prostate cancer (PCa) have been used to identify men at an earlier stage with small tumor volumes [1, 2], resulting in controversy about active surveillance and radical treatments
Given the lack of comparative study of CA vs. RP with mid-long followup period, significant uncertainties remain in considering CA as an alternative strategy to radical prostatectomy (RP) for localized PCa
The multivariable Cox regression model showed that RP was associated with higher CSS and OS rates (HR, 2.32; 95% confidence interval (CI), 1.54–3.50; P < 0.001), (HR, 2.34; 95% CI, 2.07–2.64; P < 0.001), respectively
Summary
The screening strategies of prostate cancer (PCa) have been used to identify men at an earlier stage with small tumor volumes [1, 2], resulting in controversy about active surveillance and radical treatments. Cryoablation vs Radical Prostatectomy of ablation therapy [4, 5] and reported a good oncological efficacy of it in patients with localized PCa [6, 7]. Some single-arm case series showed that CA has a favorable short-intermediate term oncological efficacy in patients with clinically low-intermediate risk PCa [8, 9]. Other studies comparing radical prostatectomy (RP) and CA reported comparable oncological outcomes between the two interventions [10, 11]. Given the lack of comparative study of CA vs RP with mid-long followup period, significant uncertainties remain in considering CA as an alternative strategy to radical prostatectomy (RP) for localized PCa. the present study aimed to validate the efficacy of CA for low-intermediate risk localized PCa compared with RP
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