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 & Objective: The use of cryoablation as an initial treatment for localized prostate cancer has increased. It is often utilized as a treatment for patients with high Gleason scores based on the ability to freeze beyond the prostatic capsule. The objective of this study is to report the outcomes of primary cryoablation when used to treat Gleason 8, 9 or 10 localized prostate cancer at a large number of centers, both academic and community, which have participated in the Cryo On-Line Data (COLD) Registry.

Methods: Data from 27 centers were collected for 1608 patients who had undergone primary cryotherapy is in the registry but this analysis includes only the 77 each of whom had a Gleason of at least 8 and a minimum 24 months of follow-up. Biochemical failure was defined according to both the original ASTRO definition (3 rises) and the 2006 updated ASTRO definition of nadir+2. Biopsy was performed at the physician's discretion, but most commonly if a patient had a rising or suspicious PSA.

Results: The average age was 69.6 ± 8.2 years. Pre treatment PSA was 16.2 ± 17.9 ng/ml, the average Gleason was 8.5±0.6. Patients were followed for 39.0 ± 18.8 months (range: 24-120 months). 87% of the patients achieved a PSA nadir < 0.4 ng/ml. Five year actuarial biochemical survivals and the number of patients at risk at 5 years are 64.4 ± 6.0% and 44.6 ± 8.0% for the 3 rises and nadir+2 definitions, respectively. A total of 47 underwent post treatment biopsy. Of these, 12 showed evidence of disease resulting in a positive biopsy rate for those who underwent biopsy of 25.5%. The positive biopsy rate of the entire population was 12/77 (15.6%).

Conclusions: Cryoablation, as a primary treatment for high Gleason prostate cancer practiced over a wide spectrum of users provides demonstrable biochemical and local control for a high risk population with aggressive disease. Further efforts to improve cancer control in these high risk patients are warranted.

Authors: Jones JS

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