Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry

Shah, Taimur T.; Peters, Max; Eldred‐Evans, David; Miah, Saiful; Yap, Tet; Faure-Walker, Nicholas A.; Hosking‐Jervis, Feargus; Thomas, Benjamin; Dudderidge, Tim; Hindley, Richard G.; McCracken, Stuart; Greene, Damian; Nigam, Raj; Valério, Massimo; Minhas, Suks; Winkler, Mathias; Arya, Manit; Ahmed, Hashim U.

doi:10.1016/j.eururo.2018.12.030

Cited by 109 publications

(82 citation statements)

References 23 publications

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“…Therefore, the authors suspected that cryotherapy might not be suitable for high-risk PCa, but could become an alternative option for low-and intermediate-risk PCa. Another prospective study that enrolled intermediate-and high-risk individuals showed no discrepancy between the two risk groups [33]. More interestingly, when stratified based on PSA levels at 10 ng/ml, subgroup analyses showed that patients with PSAs higher than 10 ng/ml were more likely to develop disease recurrence.…”

Section: Discussionmentioning

confidence: 96%

Cryotherapy shows no inferiority compared with radical Prostatectomy for low-risk and intermediate-risk localized Prostate Cancer: a real-world study from the SEER database

Jin¹,

Qiu²,

Zheng³

et al. 2020

J. Cancer

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Background: For localized prostate cancer (PCa) with a low disease burden, whole-gland resection seems like overtreatment, while focal therapy, including cryosurgery, can achieve similar outcomes. We aimed at comparing the long-term survival outcomes of cryotherapy and radical prostatectomy (RP) and further exploring whether RP can be replaced by cryosurgery for those with low-risk PCa. Methods: We conducted analyses from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) and performed propensity score matching and used an instrumental variate to reduce the influence of bias and unmeasured confounders to the greatest extent. Results: In the multivariate regression, patients who received cryotherapy had higher risk of overall mortality (OM) (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.99-3.20, p < 0.001), but no significant difference was observed in decreasing cancer-specific mortality (CSM) (HR = 1.38, 95% CI 0.63-3.03, p = 0.41) after adjusting the confounders. After propensity score matching, patients who underwent cryotherapy had higher OM and CSM rates (HR = 2.70 [95% CI 1.99-3.66, p < 0.001] and HR = 2.99 [95% CI 1.19-7.48, p = 0.02], respectively). In the IV-adjusted analyses, RP was superior to cryotherapy in decreasing OM (HR = 2.52, 95% CI 1.99-3.20), while no obvious decrease of CSM was observed in the comparison of RP and cryotherapy (HR = 1.38, 95% CI 0.63-3.03). The subgroup analyses showed that RP displayed an obvious benefit in decreasing CSM (HR = 5.02, 95% CI 1.30-19.39, p = 0.02) for those with a prostate-specific antigen (PSA) level higher than 10 ng/ml. Conclusion: RP ranked as the best treatment in regard to tumor control, but the advantages of cryotherapy became evident when taking functional and oncological outcomes into account, especially for low-and intermediate-risk PCa with low PSA levels.

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Section: Discussionmentioning

confidence: 96%

Cryotherapy shows no inferiority compared with radical Prostatectomy for low-risk and intermediate-risk localized Prostate Cancer: a real-world study from the SEER database

Jin¹,

Qiu²,

Zheng³

et al. 2020

J. Cancer

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“…The distance between rectal wall and the most anterior tumour border can be defined precisely, and unsuitable cases for HIFU with a tumour location beyond the maximal focal point have to be excluded. In our practice, we now use interstitial needle based ablative therapies [12,13]. When planning a HIFU treatment for anterior prostate tumours one should bear in mind the intraprostatic changes, which are produced by heating energy through ablation.…”

Section: Discussionmentioning

confidence: 99%

Focal HIFU therapy for anterior compared to posterior prostate cancer lesions

et al. 2020

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Objective To compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach. Materials and methods In a prospectively maintained national database, 598 patients underwent focal HIFU (Sonablate ® 500) (March/2007-November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing in the first year with PSA, every 6-12 months with mpMRI with biopsy for MRI-suspicion of recurrence. Treatment failure was any secondary treatment (ADT/chemotherapy, cryotherapy, EBRT, RRP, or re-HIFU), tumour recurrence with Gleason ≥ 3 + 4 on prostate biopsy without further treatment or metastases/prostate cancer-related mortality. Cases with anterior cancer were compared to those with posterior disease. Results 267 patients were analysed following eligibility criteria. 45 had an anterior focal-HIFU and 222 had a posterior focal-HIFU. Median age was 64 years and 66 years, respectively, with similar PSA level of 7.5 ng/ml and 6.92 ng/ml. 84% and 82%, respectively, had Gleason 3 + 4, 16% in both groups had Gleason 4 + 3, 0% and 2% had Gleason 4 + 4. Prostate volume was similar (33 ml vs. 36 ml, p = 0.315); median number of positive cores in biopsies was different in anterior and posterior tumours (7 vs. 5, p = 0.009), while medium cancer core length, and maximal cancer percentage of core were comparable. 17/45 (37.8%) anterior focal-HIFU patients compared to 45/222 (20.3%) posterior focal-HIFU patients required further treatment (p = 0.019). Conclusion Treating anterior prostate cancer lesions with focal HIFU may be less effective compared to posterior tumours.

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“…During cryoablation, the probes are placed using two-dimensional (2D) image guidance for localization of prostate tumor, and the lesion is targeted visually (aka with cognitive fusion). The development of three-dimensional (3D) treatment volumes of ice at − 40 °C ensures tissue destruction [ 15 ]. Standard of care cryoablation is achieved by placing cryoprobes into the tissue under 2D ultrasound guidance.…”

Section: Introductionmentioning

confidence: 99%

MRI guided procedure planning and 3D simulation for partial gland cryoablation of the prostate: a pilot study

et al. 2020

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Purpose This study reports on the development of a novel 3D procedure planning technique to provide pre-ablation treatment planning for partial gland prostate cryoablation (cPGA). Methods Twenty men scheduled for partial gland cryoablation (cPGA) underwent pre-operative image segmentation and 3D modeling of the prostatic capsule, index lesion, urethra, rectum, and neurovascular bundles based upon multi-parametric MRI data. Pre-treatment 3D planning models were designed including virtual 3D cryotherapy probes to predict and plan cryotherapy probe configuration needed to achieve confluent treatment volume. Treatment efficacy was measured with 6 month post-operative MRI, serum prostate specific antigen (PSA) at 3 and 6 months, and treatment zone biopsy results at 6 months. Outcomes from 3D planning were compared to outcomes from a series of 20 patients undergoing cPGA using traditional 2D planning techniques. Results Forty men underwent cPGA. The median age of the cohort undergoing 3D treatment planning was 64.8 years with a median pretreatment PSA of 6.97 ng/mL. The Gleason grade group (GGG) of treated index lesions in this cohort included 1 (5%) GGG1, 11 (55%) GGG2, 7 (35%) GGG3, and 1 (5%) GGG4. Two (10%) of these treatments were post-radiation salvage therapies. The 2D treatment cohort included 20 men with a median age of 68.5 yrs., median pretreatment PSA of 6.76 ng/mL. The Gleason grade group (GGG) of treated index lesions in this cohort included 3 (15%) GGG1, 8 (40%) GGG2, 8 (40%) GGG3, 1 (5%) GGG4. Two (10%) of these treatments were post-radiation salvage therapies. 3D planning predicted the same number of cryoprobes for each group, however a greater number of cryoprobes was used in the procedure for the prospective 3D group as compared to that with 2D planning (4.10 ± 1.37 and 3.25 ± 0.44 respectively, p = 0.01). At 6 months post cPGA, the median PSA was 1.68 ng/mL and 2.38 ng/mL in the 3D and 2D cohorts respectively, with a larger decrease noted in the 3D cohort (75.9% reduction noted in 3D cohort and 64.8% reduction 2D cohort, p 0.48). In-field disease detection was 1/14 (7.1%) on surveillance biopsy in the 3D cohort and 3/14 (21.4%) in the 2D cohort, p = 0.056) In the 3D cohort, 6 month biopsy was not performed in 4 patients (20%) due to undetectable PSA, negative MRI, and negative MRI Axumin PET. For the group with traditional 2D planning, treatment zone biopsy was positive in 3/14 (21.4%) of the patients, p = 0.056. Conclusions 3D prostate cancer models derived from mpMRI data provide novel guidance for planning confluent treatment volumes for cPGA and predicted a greater number of treatment probes than traditional 2D planning methods. This study prompts further investigation into the use of 3D treatment planning techniques as the increase of partial gland ablation treatment protocols develop.

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Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry

Cited by 109 publications

References 23 publications

Cryotherapy shows no inferiority compared with radical Prostatectomy for low-risk and intermediate-risk localized Prostate Cancer: a real-world study from the SEER database

Cryotherapy shows no inferiority compared with radical Prostatectomy for low-risk and intermediate-risk localized Prostate Cancer: a real-world study from the SEER database

Focal HIFU therapy for anterior compared to posterior prostate cancer lesions

MRI guided procedure planning and 3D simulation for partial gland cryoablation of the prostate: a pilot study

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