Focal Cryoablation of the Prostate: Primary Treatment in 163 Patients With Localized Prostate Cancer

Area of Science:

• Urology
• Oncology
• Minimally Invasive Surgery

Background:

• Whole gland prostate cancer treatment is effective but linked to significant morbidity like erectile dysfunction and urinary incontinence.
• Focal ablative therapies, such as focal cryoablation (FC), aim to reduce these side effects while managing cancer progression.
• There is ongoing debate regarding the optimal treatment for intermediate and high-risk prostate cancer, with growing interest in focal therapy.

Purpose of the Study:

• To evaluate the oncologic outcomes and side effects of focal cryoablation (FC) in a cohort of 163 prostate cancer patients.
• To assess the biochemical recurrence (BCR) and biochemical disease-free survival rates following FC across different risk groups.
• To explore the prognostic impact of pre-operative factors and genomic sequencing on treatment outcomes.

Main Methods:

• A retrospective analysis of 163 T1c prostate cancer patients treated with FC between November 2008 and December 2020.
• Biochemical recurrence (BCR) was defined using the ASTRO and Phoenix criteria.
• Oncologic outcomes, patient-reported side effects (urinary incontinence, erectile dysfunction), and prognostic factors were analyzed using Cox proportional hazard analyses, logistic regression, and Kaplan-Meier methods.

Main Results:

• The cohort comprised low (16.5%), intermediate (70.5%), and high-risk (14.1%) prostate cancer patients.
• A 73% reduction in prostate-specific antigen (PSA) was observed one month post-FC.
• Five-year biochemical disease-free recurrence rates were 78% (low), 74% (intermediate), and 55% (high-risk). Urinary incontinence and erectile dysfunction were reported in 1.8% and 3.1% of patients, respectively.

Conclusions:

• Focal cryoablation (FC) demonstrates favorable oncologic outcomes and acceptable side effect profiles for various prostate cancer risk groups.
• The study contributes to the evidence supporting focal ablative therapies as an alternative to whole gland treatment.
• Further research is needed to fully establish the long-term efficacy and optimal application of FC in prostate cancer management.