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Focal cryotherapy in the treatment of localized prostate cancer: early outcomes

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Focal Cryotherapy in the Treatment of Localized Prostate Cancer: Early Outcomes

Taimur T. Shah1-3, Benjamin Thomas1, Massimo Valerio1,2, Maneesh Ghei1, 3, Hashim U. Ahmed1,2, Manit Arya1,2,4

1.Division of Surgery and Interventional Science, University College London (UCL)  2. Department of Histopathology, UCLH NHS Foundation Trust, London

3. Department of Urology, Whittington Hospital, London   4. Derpartment of Urology, Princess Alexandra NHS Trust, Harlow

 

Introduction

 

Focal cryotherapy may offer good short-medium term oncological outcomes with minimal side-effects. We recently started a focal cryotherapy program and created a prospective registry to monitor safety, adverse-events, functional outcomes and disease control.

 

Methods

 

All patients undergoing focal cryotherapy had their clinical and patient reported outcome data (IPSS, EPIC, IIEF-15) collected prospectively, pre-operatively and for up to 1 year post-operatively.

 

All patients had their diagnosis made by either transperineal template or mpMRI targeted biopsies.

IMAGE: 

Left – Diffusion Weighted (DWI) multi-parametric MRI showing restricted diffusion of a left anterior lesion

Middle - All procedures were performed using the SeedNet system (Galil Medical) with intraoperative US monitoring of the ice ball.

Right – Post- operative dynamic contrast enhanced (DCE) image showing no enhancement of treated area.

 

 

Between October 2013 and January 2015, 37 patients underwent primary focal cryotherapy and 13 underwent salvage treatment. 


Results


Primary Cohort:

•Median post-operative PSA dropped by 82% to 1.85.
 
•78% returned at least 1 post-operative questionnaire.
 
•Results showed no incontinence (defined as any pad-usage).
 
•IIEF-15 scores fluctuated even in the same patient at different time points and thus assessing best post-operative IIEF-15 score for each patient showed a minimal, median decrease of 5.5 points. In addition 7/24 (29%) who were not previously on ED treatment were started on PDE5i’s.
 
•Median IPSS scores improved from 6.5 pre-operatively to 4.5 at 9 months before returning to baseline at 12 months.
 
•Also, at all time points no significant change was seen in the EPIC score. 


Salvage Cohort:

•Median PSA dropped by 85% to 1.06ng/ml.
 
•Only 54% returned their questionnaires, making firm conclusions difficult.
 
•No patient became incontinent and there was no significant change in their IPSS, EPIC or IIEF-15 scores post-operatively.
 
 
Overall Results

 

Other adverse-events occurred in 11/50 patients (22%): 6 AURs, 5 UTI’s, 1 haematuria and 1 penile-tip numbness.

 

Our early oncological outcomes show a greater than 80% drop in PSA with a biochemical failure rate of 0% and a 0% re-treatment rate.

 

Conclusion

 

Our early results show minimal side-effects conferred by focal cryotherapy. Continued follow-up will determine the medium to long-term disease control.

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