Contemporary Results of Focal Therapy for Prostate Cancer Using Cryoablation

Abstract

The concept of focal therapy is rapidly evolving and gaining popularity from both physician and patient perspectives. We review the rationale, candidate selection, and results of the first clinical studies of focal cryoablation for selected patients with low volume and low-to low-moderate-risk features of prostate cancer as an alternative to whole-gland treatment. In spite of improved understanding of the tumor biology of early stage disease, we currently have limited tools to select appropriate patients with low-to low-moderate risk unifocal or unilateral prostate cancer who may be amenable to focal therapy. From a technical point, a number of ablative treatment options for focal therapy are available, with cryoablation having the most clinical experience. Recently, several reports have been published from single and multi-institutional studies that discuss focal therapy as a reasonable balance between cancer control and quality-of-life outcomes. Retrospective pathologic data from large prostatectomy series, however, do not clearly reveal valid and reproducible criteria to select appropriate candidates for focal cryoablation because of the complexity of tumorigenesis in early stage disease. At this time, a more feasible option remains hemiablation of the prostate with reasonable certainty about the absence of clinically significant cancer lesion(s) on the contralateral side of the prostate based on three-dimensional transperineal prostate biopsy mapping studies. Minimally invasive, parenchyma-preserving cryoablation can be considered as a potential feasible option in the treatment armamentarium of early stage, localized prostate cancer in appropriately selected candidates. There is a need to further test this technique in randomized, multicenter clinical trials.

Focal cryoablation: a treatment option for unilateral low‐risk prostate cancer

“…We carried out FC using the Precise TM cryoablation system (Galil Medical, Inc., Arden Hills, MN, USA) using an argon gas‐based system and ultra‐thin 17 gauge (1.47 mm) cryoablation needles (Galil Medical). Needles were placed via a transperineal approach using a template under ultrasound guidance in the ipsilateral lobe, where the index lesion was biopsied, to perform a hemi‐ablation.…”

Cryoablation induced the change of TGF-β pathway in CWR-22RV prostate cancer cell line

“…Cryosurgery is minimally invasive technique that has proven to be effective in the treatment of patients with prostate cancer (PCa) [14]. This treatment destroys tumor tissue in situ by freezing, leaving tumor proteins and tumor-associated antigens intact, which can potentially modulate the host's immune response [17].…”

Prise en charge des tumeurs de la prostate à faible risque évolutif

“…Le pourcentage de biopsies de contrôle positives est de 26 % vs 15 %. En traitement focal, les taux de complications sont de 1,6 % d'incontinence et 42 % de troubles de l'érection sur une série de 1160 cas [49,50].…”