Comparative Effectiveness of Partial Gland Cryoablation Versus Robotic Radical Prostatectomy for Cancer Control

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Limited high-level evidence exists comparing oncologic endpoints for partial gland ablation versus radical prostatectomy.
• Existing studies often rely on prostate-specific antigen (PSA) rather than biopsy-based endpoints.

Purpose of the Study:

• To compare oncologic outcomes between partial gland cryoablation (PGC) and radical prostatectomy (RP) as primary treatments for intermediate-risk prostate cancer.
• To evaluate treatment failure rates and survival analyses between the two treatment modalities.

Main Methods:

• Retrospective, single-center analysis of 173 patients (75 PGC, 98 RP) treated between January 2017 and December 2022.
• Inclusion criteria focused on intermediate-risk prostate cancer (Gleason grade group 2-3).
• Oncologic endpoints included surveillance biopsies (PGC) and serial PSA testing (RP), with treatment failure defined as need for salvage treatment or metastasis.

Main Results:

• Partial gland cryoablation (PGC) was associated with significantly higher rates of treatment failure at 24 months (33% vs. 11%) and 48 months (43% vs. 14%) compared to radical prostatectomy (RP).
• Adjusted analysis revealed PGC carried a nearly fivefold higher risk of treatment failure (Hazard Ratio 4.6).
• Metastatic disease development was similar between groups (2.1% PGC vs. 0.7% RP by 48 months).

Conclusions:

• This comparative study indicates a substantially higher risk of treatment failure with partial gland cryoablation (PGC) compared to radical prostatectomy (RP) in the short-term follow-up.
• Patients with intermediate-risk prostate cancer should be counseled on the increased risk of treatment failure associated with PGC.