Cryotherapy for low risk prostate cancer, oncological and functional medium term outcomes: A three center prospective study

Abstract

Objectives: Analyze the oncologic and functional outcomes in patients affected by low risk prostate cancer underwent prostate cryotherapy. Materiasl and methods: It’s a prospective tricentric study of 434 patients treated with prostate cryoablation for low risk prostate cancer. By low risk we refer to the D'Amico’s risk classification. Two cycles of freezing/thawing are run for each patient following the technique described by Onik. Results: For the 434 patients, the median age was 66 years with a standard deviation of ± 6.68, the average PSA was 6.17 ng/d/L, the median 5.55 with a standard deviation of ± 2.13, the mean prostate volume was 35.59 cc, the median 34.00 cc, with a standard deviation of ± 7.89. Biochemical failure occurred in 67 patients (15.4%). Pre-operative erectile function in men was distributed as follows: severe in 95 patients (19.2%), moderate in 95 (19.2%), medium-moderate in 180 (36.4%), mild in 92 (18.6%), with no dysfunction in 32 (6.5%) patients. Post-operative erectile function, measured 1 month after cryotherapy, was distributed as follows: severe in 321 (65%) patients, moderate in 69 (14%), medium-moderate in 79 (16%), mild in 23 (4.7%), and no dysfunction in only 2 patients (0.4%). Post-operative erectile function after 3 months was distributed as follows: severe in 233 (47.2%) patients, moderate in 66 (13.4%), medium-moderate in 122 (24.7%), mild in 65 (13.2%), and no dysfunction in 8 patients (1.6%). Urinary incontinence was present in 21 patients (4.8%) after 3 months while it dropped to 13 patients (2.9%) after 6 months. Conclusions: Cryotherapy in the treatment of prostate cancer remains a viable alternative. The availability of new cryoprobes and the use of new diagnostic means such as fusion magnetic resonance will make this more precise and more effective method.

Does the type of cryoprobe affect oncological and functional outcomes in men with clinically localized prostate cancer treated with primary whole gland prostate cryoablation?

“…[ 14 , 16 , 17 ] Several studies have shown that the rate of biochemical failure in patients who have been treated with primary whole gland cryotherapy using cryoprobes of 2.4 mm diameter ranged between 15 and 21% during early follow-up in the initial 24 months. [ 15 , 18 , 19 ] In our study, the rate of recurrence at 24 months is 8% in the V-Probe ® group and 10% in the fixed-size ice probe. We believe this may be in part because 48.5% of our cohort consisted of Gleason 6 on pretreatment biopsy.…”

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

“…Among the 26 studies [23][24][25][26][27][28][29][30][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] included (Table 3…”

“…Only one study [21] reported a PSA decrease of 2 ng/mL. Seven studies [25,26,40,44,47,48,50] assessed recurrence rate using the ASTRO Phoenix definition, whereas two studies [27,43] reviewed the rate of positive post-procedural prostate biopsy. The overall recurrence rate ranged from 15.4% to 62% (using the Phoenix definition, from 15.4% to 40.3%), whereas the overall positive recurrence rate by prostate biopsy ranged from 18% to 62% (Table 5).…”

Comparative analysis of minimally invasive methods of treatment of localized prostate cancer

“…Столь сильное ухудшение было также продемонстрировано в исследовании Е. Lucan и соавт. (2019), результаты которого показали прирост количества пациентов с эректильной дисфункцией после криоабляции (65 %) по сравнению с предоперационным уровнем (19,2 %) [25]. По данным литературы, после брахитерапии результаты более благоприятные.…”