MP73-19 FOCAL CRYOABLATION VS FOCAL HIGH INTENSITY FOCUSED ULTRASOUND FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP73-19 FOCAL CRYOABLATION VS FOCAL HIGH INTENSITY FOCUSED ULTRASOUND FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER Masatomo Kaneko, Alireza Ghoreifi, Samuel Peretsman, Jessica Cummins, Lorenzo Storino Ramacciotti, Giovanni E. Cacciamani, Amir H. Lebastchi, Suzanne L. Palmer, Manju Aron, Osamu Ukimura, Duke Bahn, Inderbir Gill, and Andre Luis Abreu Masatomo KanekoMasatomo Kaneko More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Samuel PeretsmanSamuel Peretsman More articles by this author , Jessica CumminsJessica Cummins More articles by this author , Lorenzo Storino RamacciottiLorenzo Storino Ramacciotti More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , Amir H. LebastchiAmir H. Lebastchi More articles by this author , Suzanne L. PalmerSuzanne L. Palmer More articles by this author , Manju AronManju Aron More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Duke BahnDuke Bahn More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess outcomes of focal Cryoablation (CRYO) and focal High Intensity Focused Ultrasound (HIFU) for Intermediate to high-risk prostate cancer (PCa). METHODS: Consecutive patients who underwent hemi-gland CRYO (h-CRYO) or hemi-gland HIFU (h-HIFU) as primary treatment for D’Amico intermediate risk and high-risk PCa were identified (IRB# HS-17-00749). Patients were followed by prostate biopsy (PBx) 6-12 mo and every 2 yr thereafter. The primary endpoint was treatment failure (TF) defined as Grade Group (GG) ≥2 on follow-up (FU) PBx, any whole-gland treatment, systemic therapy, metastases, or PCa-specific mortality. Secondary endpoints included survival-free from i) biochemical failure (BF, PSA nadir+2 ng/mL); ii) GG≥2 on FU-PBx, and iii) radical treatment. Kaplan-Meier and Cox regression analyses were performed for survival evaluation. International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were evaluated. Statistically significant if p<0.05. RESULTS: A total of 294 patients met the inclusion criteria: 192 (65%) CRYO and 102 (35%) HIFU. The baseline characteristics were comparable between h-CRYO vs h-HIFU, as follows: median age (68 vs 66yr, p=0.2), PSA (6.6 vs 6.1 ng/mL, p=0.08), PSA density (PSAD, 0.17 vs 0.16 ng/mL2, p=0.6), respectively. The distribution of GG for h-CRYO vs h-HIFU were as follows: GG1 (7.3% vs 2.0%), GG2-3 (77% vs 93%), and GG4-5 (15% vs 5.0%) (p<0.004), respectively. The median FU was longer for h-CRYO (46 mo) vs h-HIFU (22 mo); p<0.001. The 3-year TF-free survival was: 86% for h-CRYO and 62% for h-HIFU, p=0.003. PSAD per 0.01 was an independent predictor of TF on multivariate Cox regression analysis (hazard ratio [HR] 1.02, 95% confidence interval [95%CI] 1.01-1.03), but h-HIFU vs h-CRYO was not (HR 1.27, 95%CI 0.69-2.33). The 3-year free survival were, for h-CRYO vs h-HIFU: BF (75% vs 81%, p=0.76); GG≥2 on FU-PBx (88% vs 62%, p<0.001), and radical treatment (97% vs 83%, p=0.1), respectively. PSAD per 0.01 and the number of cancer cores on baseline PBx were independent predictors of GG≥2 on FU-PBx, but h-HIFU vs h-CRYO was not (HR 1.34, 95%CI 0.72-2.48). The median difference from pre- to post-FT IPSS (0 vs 1; p=0.27) was similar for h-CRYO vs h-HIFU, respectively. The median IIEF-5 decreased more after CRYO than HIFU (2 vs 0; p=0.005). Continence (zero pad) was maintained in 97% for h-CRYO and in 97% for h-HIFU (p=1.00). CONCLUSIONS: Hemi-gland CRYO and HIFU provide comparable and acceptable medium-term oncologic outcomes for intermediate-high risk PCa, with excellent functional outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1043 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masatomo Kaneko More articles by this author Alireza Ghoreifi More articles by this author Samuel Peretsman More articles by this author Jessica Cummins More articles by this author Lorenzo Storino Ramacciotti More articles by this author Giovanni E. Cacciamani More articles by this author Amir H. Lebastchi More articles by this author Suzanne L. Palmer More articles by this author Manju Aron More articles by this author Osamu Ukimura More articles by this author Duke Bahn More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF downloadLoading ...