Objective: To report (1) intermediate-term oncologic and functional outcomes of primary focal cryoablation (FC) in selected patients with clinically unilateral, low-intermediate-risk prostate cancer, and investigate (2) the impact of patient selection criteria at predicting outcomes after FC.
Materials and methods: Forty-one patients with unilateral prostate cancer were treated with FC. Patients were stratified using the 2007 Task Force Focal Prostate Cancer Patient selection criteria (Task Force criteria). Posttherapy follow-up included questionnaires, PSA measurement, and TRUS-guided biopsies.
Results: Complete follow-up was available in 40 patients (median follow-up 63 months; range 12-92 months). Compared to precryotherapy PSA level (mean 7.1 ng/ml), postcryotherapy PSA level (mean 1.8 ng/ml) dropped by 75 % at 3 months (P < 0.0001) and this decline persisted throughout the follow-up period, with no significant difference seen across patient selection criteria (P = 0.859). The treatment failure rate was 10 % (4/40) with no significant difference seen across patient selection criteria (P = 0.832). Of 32 patients undergoing postcryotherapy biopsy, 7 (22 %) had positive biopsies (2 ipsilateral lobes, 5 contralateral lobes). Patients of Task Force criteria group were less likely to have positive biopsy in contralateral lobe than focal control group (P = 0.032). Complete continence (no pads) and potency sufficient for intercourse were documented in 97.6 and 76.9 % of patients, respectively.
Conclusions: The intermediate-term oncologic efficacy of primary FC in selected patients with clinically unilateral, low-intermediate-risk prostate cancer appears favorable, and the side-effect profile is low. The 2007 Task Force criteria appear to reduce the positive biopsy rate in contralateral lobe after FC.
Keywords: Carcinoma; Cryoablation; Focal; Prostatic neoplasms.