Focal Cryo-ablation for Treatment of Intermediate Favorable Risk (Grade Group 2) Prostate Cancer

To report 7-year oncological outcomes of focal cryo-ablation (FCA) for focal intermediate favorable-risk prostate cancer (IFRPCa).

Beginning March 2017, all men with focal IFRPCa undergoing FCA meeting the following eligibility criteria were enrolled in our longitudinal prospective study: a single MRI Prostate Imagine-Reporting and Data System (PIRADS) 2-5 target concordant with unilateral IFRPCa, no gross extraprostatic extension or very distal apical disease on MRI, and no Grade Group (GG) ≥2 contralateral to the MRI target. The oncological surveillance protocol included PSA testing every 6 months and MRI testing at 6-12 months, 2, 3.5, 5.0, and 7.5 years. Prostate biopsy was performed for rising PSA, suspicious MRI's or at the discretion of the surgeons. The main outcome measure was clinically significant prostate cancer (csPCa) recurrence.

Two hundred seventy-six men were enrolled in the study. Overall, 39 (14.1%) developed a csPCa recurrence. Baseline mean PSA was significantly greater in subjects developing csPCa recurrence. There were no prostate cancer mortalities, and 3 (0.01%) developed metastasis. The csPCa recurrence-free survival at 3, 5, and 7 years was 90.20%, 78.36%, and 70.31%, respectively. African American race was the only significant independent predictor for developing a csPCa recurrence. Compliance with protocol MRI at 7.5 years was 90.9%.

The present study supports FCA as a treatment option for focal IFRPCa associated with an MRI target with no evidence of extra-capsular extension or distal apical disease on MRI, and no contralateral GG >1 disease.