Hemigland Cryoablation of Localized Low, Intermediate and High Risk Prostate Cancer: Oncologic and Functional Outcomes at 5 Years

Oishi, Masamichi; Gill, Inderbir S.; Tafuri, Alessandro; Shakir, Aliasger; Cacciamani, Giovanni; Iwata, Takashi; Iwata, Atsuko; Ashrafi, Akbar; Park, Daniel; Cai, Jie; Desai, Mihir; Ukimura, Osamu; Bahn, Duke; Abreu, André Luís de Castro

doi:10.1097/ju.0000000000000456

Cited by 51 publications

(64 citation statements)

References 26 publications

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“…Any comparison of this result with others in the literature must be taken cautiously, as erectile function after focal therapy is highly location dependentif ablation was taken in the posterolateral area, there would be a direct impact on the ipsilateral nerve, whereas an anterior ablation would spare both nerves and be more likely to preserve function. 3,4 Although long-term oncological outcomes were outside the scope of this pilot study, the 6-month re-biopsy findings showed that the infield negative biopsy rate was 70%, which…”

Section: Editorial Commentmentioning

confidence: 84%

“…HIFU destroys PC within the prostate through heat coagulation and mechanical effects, and the size of a single therapeutic focus of HIFU is a few millimeters in diameter, with a distinct margin between the treated area and the adjacent untreated tissue. 4 These characteristics make HIFU an attractive therapeutic modality for focal therapy in patients with PC. 2,4 However, the use of transrectal HIFU is limited in patients with an anteriorly localized target in a large prostate (≥50 mL) or large calcification in the prostate (diameter of ≥10 mm).…”

mentioning

confidence: 99%

“…4 These characteristics make HIFU an attractive therapeutic modality for focal therapy in patients with PC. 2,4 However, the use of transrectal HIFU is limited in patients with an anteriorly localized target in a large prostate (≥50 mL) or large calcification in the prostate (diameter of ≥10 mm). Therefore, the proper use of the modalities was proposed based on the tumor location and other conditions.…”

mentioning

confidence: 99%

“…Similarly, depending on the end-points evaluated, many studies report encouraging successful treatment rates with mid-term oncological outcomes comparable with standard of care treatments. [2][3][4] Certainly, there are several unmet needs for PCa PGA. There is still a clear need to establish more accurate imaging for appropriate patient selection and follow up, optimal energy/device sources and treatment strategies (i.e.…”

mentioning

confidence: 99%

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Editorial Comment from Dr Kaneko et al. to Focal bipolar radiofrequency ablation for localized prostate cancer: Safety and feasibility

2020

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Section: Editorial Commentmentioning

confidence: 84%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Editorial Comment from Dr Kaneko et al. to Focal bipolar radiofrequency ablation for localized prostate cancer: Safety and feasibility

2020

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“…The author's conclusion was that hemigland cryoablation offers an effective medium-term oncologic outcome. 59 MR-guided percutaneous cryoablation combines excellent soft-tissue resolution and rapid ice ball monitoring (due to loss of MRI signal in frozen tissue) without the use of MRI thermometry. Early experience combining cryoablation with MRI has shown a high degree of accuracy in defining normal and frozen tissue on all MR imaging sequences.…”

Section: Focal Ablation Treatment Patternsmentioning

confidence: 99%

Magnetic Resonance–Guided Prostate Ablation

Woodrum

Kawashima

Gorny

et al. 2019

Semin intervent Radiol

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In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade “localized” prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.

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Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

et al. 2023

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Background Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa). Methods 143 men with unilateral csPCa were enrolled in a prospective, observational trial of outpatient PGA‐cryotherapy. Treatment was a 2‐cycle freeze of the affected prostate part. Participants were evaluated with MRI‐guided biopsy (MRGB) at baseline and at 6 months and 18 months after treatment. Absence of csPCa upon MRGB was the primary endpoint; quality‐of‐life at baseline and at 6 months after treatment was assessed by EPIC‐CP questionnaires in the domains of urinary and sexual function. Results Of the 143 participants, 136 (95%) completed MRGB at 6 months after treatment. In 103/136 (76%), the biopsy revealed no csPCa. Of the 103, 71 subsequently had an 18‐month comprehensive biopsy; of the 71 with 18‐month biopsies, 46 (65%) were found to have no csPCa. MRI lesions became undetectable in 96/130 (74%); declines in median serum PSA levels (6.9 to 2.5 ng/mL), PSA density (0.15 to 0.07), and prostate volume (42 to 34cc) were observed (all p < 0.01). Neither lesion disappearance on MRI nor PSA decline correlated with biopsy outcome. Urinary function was affected only slightly and sexual function moderately. Conclusion In the near to intermediate term, partial gland ablation with cryotherapy was found to be a safe and moderately effective treatment of intermediate‐risk prostate cancer. Eradication of cancer was better determined by MRI‐guided biopsy than by MRI or PSA.

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Hemigland Cryoablation of Localized Low, Intermediate and High Risk Prostate Cancer: Oncologic and Functional Outcomes at 5 Years

Cited by 51 publications

References 26 publications

Editorial Comment from Dr Kaneko et al. to Focal bipolar radiofrequency ablation for localized prostate cancer: Safety and feasibility

Editorial Comment from Dr Kaneko et al. to Focal bipolar radiofrequency ablation for localized prostate cancer: Safety and feasibility

Magnetic Resonance–Guided Prostate Ablation

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

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