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Cryosurgical hemiablation for low and intermediate risk of prostate cancer: 4 years of functional and initial oncological outcomes

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CRYOSURGICAL HEMIABLATION FOR LOW AND INTERMEDIATE RISK OF PROSTATE CANCER: 4 years of functional and initial oncological outcomes

Giovanni Silecchia1, Luigi Cormio1, Oscar Selvaggio1, Rocco Di Brina1, Giuseppe Carrieri1
1 Division Of Urology, University Of Foggia, Foggia (FG)

 

OBJECTIVE:  Currently there are many different options for treatments of prostate cancer, particularly for the low and intermediate risk variety from D'Amico’s

risk classification (1).
 According to the latest EAU guidelines there are different types of standard treatments for low and intermediate risk prostate cancer among

which Cryoablation therapy. The goal of surgery is to eradicate the disease by preserving continence and sexual potency when possible (2). The aim of this study

was to determine safety and success of cryo-hemiablation of prostate cancer in terms of early functional recovery of erectile function, urinary continence,

perioperative/ postoperative complications and good oncological control.

 MATERIALS and METHODS: We performed a retrospective analysis of 45 patients who underwent focal hemiablation for biopsy proven unilateral prostate

cancer ( < T2b). All patients underwent an entry-staging biopsy. Potency was defined as the ability to penetrate quantified pre- and post-operatively as a

score > 3 for IIEF-5 question 2.

All patients underwent to post-operatively stress-test to evaluate onset of stress incontinence.

Serum PSA was sampled every three months for the first 2 years than every 6 months for 5 years and every 1 year for 10 years.

Biochemical failure was defined according to Phoenix criteria of PSA rising > 2 ng/ml of nadir (3).

All patients with biochemical failure underwent to target biopsy.

Local recurrence was defined as prostate cancer in treated lobe; tumor progression was defined as prostate cancer in non-treated lobe.

Complications were scored using the Clavien-Dindo scale. Every patient had signed a specific informed consent.

This study was carried out in agreement with applicable laws and regulation good clinical practice and ethical principles as described in the Declaration of Helsinki

in1975 and revised in Tokyo in 2008.

 

RESULTS: From February 2013 to September 2017, 45 pts meeting inclusion criteria, after signed informed consent, underwent entry-staging  biopsy and then

were treated with cryo-hemiablation of prostate. Patients’s characteristics and pathological features are reported in table 1. Median follow-up is 59,72 months

but in this paper we reported data about 1-year follow-up because of longer follow-up oncological data are in a reviewing phase. Concernig erectile

function 84,4% (38/45) had IIEF-5 question 2 > 3 pre-operatively; at 3 months post-operative this rate has remained unchanged.

No urinary stress incontinence was reported by any patient and all stress test resulted negative for urine leakage. We do not register

any major complications (Clavien-Dindo >  3) either intraoperatively than postoperatively.

Biochemical failure was registered in 4 patients at 1 year; all of them  underwent saturation biopsy with diagnosis of cancer progression

and then to a radical cryoablation of prostate with, actually, undosable PSA.

At 4 years of follow-up no patients showed distant metastases.

                                                                                                                           

DISCUSSION: Our study, although retrospective, highlights how the cryo-hemiablation of prostate cancer, is a feasible and safe procedure which guarantees

preservation either sexual power than urinary continence in high selected group of patients. From an oncological point of view to assess its efficacy occur longer

follow-up data  which are currently under revision.

 

CONCLUSIONS: Cryo-hemiablation of prostate cancer preserves both urinary continence and erectile function. Currently given the short follow-up no oncological

conclusions can be drawn in this paper

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