Presented Wednesday, 05 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Prostate cryoablation is associated with a high rate of post treatment erectile dysfunction. Focal cryoablation (FC) is a modification of the procedure in which only those regions known to harbor cancer are treated with aggressive freezing and uninvolved regions are spared (including a neurovascular bundle). During nerve warming cryoablation (NWC) the entire prostate is targeted for ablation and a warming probe is placed near one or both nerves to spare it from an ablative freeze injury. The objective of this study is to report the outcomes of both FC and NWC at a large number of centers, both academic and community, which have participated in the Cryo On-Line Data (COLD) Registry. To the au- thors' knowledge, this is the largest report of its kind to date.

Methods: Deidentified patient data were retrospectively collected on the secure online data registry. Biochemical failure defined according to the 2006 revised ASTRO definition (nadir+2). Patients underwent biopsy for rising or suspicious PSA. Incontinence was defined as any leak of urine 12 months post treatment and further stratified according to pad use. Potency was defined as the ability to vaginally penetrate and complete intercourse 12 months after therapy and was stratified according to required assistance.

Results: Ten physicians entered data on 240 patients. KM analysis demonstrated three year actuarial biochemical disease free survival of 83.6±4.5% for FC patients and two year survival of 81.5±6.9% for NWC patients. Of those patients biopsied 3/21 (14.6%) and 1/6 (16.7%) demonstrated residual or recurrent disease following FC and NWC, respectively. Potency outcomes are presented in the table. 

Conclusion: Potency does not appear to be well preserved after NWC compared to FC. Although the follow-up of both procedures is short they both have encouraging biochemical control and biopsy results. Long term follow-up is needed to determine the cancer control of focal cryoablation

Authors: Rewcastle JC, Katz AE, Donnelly BJ, Pisters LL, Lugnani FM, Jones JS

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