Whole and hemi-gland cryoablation for primary localized prostate cancer: Short and medium-term oncological and functional outcomes

Abstract

IntroductionTo compare oncological, functional and post-operative outcomes of hemi (HC) vs whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. Material and methodSixty-six consecutive patients undertaking whole-gland cryoablation (WGC=40) or hemi-cryoablation (HC=26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D’Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir + ≥2ng/mL), 2) positive prostate re-biopsy with Gleason score≥7, 3) initiation of further prostate cancer treatment. ResultsMedian patients age at treatment was 74 [42–81] vs 76 [71–80] years in WGC vs HC group, respectively (p=0.08). Low and intermediate D’Amico risk group were 15% and 85% vs 23% and 77% (p=0.75), respectively. Median follow- up time was 41[1.5–99.0] vs 27 [0.9–93] months (p=0.03). Four-years cryotherapy failure free survival in WGC vs HC were 69% vs 53% with definition 1 (p=0.24), 82% vs 80% with definition 2 (p=0.95), 83% vs 77% with definition 3 (p=0.73).Early and 1-year urinary continence were 60% and 83% in WGC vs 72% and 83% in HC (p=0.26). De novo impotency after cryotherapy was 75% vs 46% (p=0.33) in WGC vs HC. ConclusionsIn our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation.