To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer, when patient selection and follow-up includes MRI-guided biopsy.
29 men with unilateral prostate cancer (all clinically significant with prostate volume <60cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median PSA was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life.
Cryotherapy was completed satisfactorily in all 29 cases in < 60 minutes with no intra-operative complications. Significant decreases in PSA (median decrease 5.6 ng/ml) and PSA density (median decrease 0.14 ng/ml/cc) were observed (p<0.01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. 3 patients (10%) revealed micro-residual disease. 3 patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only two, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was one case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged.
Hemi-gland cryoablation for clinically-significant prostate cancer is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.
Urology. 2019 Jan 16 [Epub ahead of print]
Steve R Zhou, Demetrios N Simopoulos, Rajiv Jayadevan, Ely R Felker, Merdie K Delfin, Danielle E Barsa, Lorna Kwan, Leonard S Marks
David Geffen School of Medicine, University of California at Los Angeles, 885 Tiverton Drive, Los Angeles, CA 90095., Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, 300 Stein Plaza, 3rd Floor, Los Angeles, CA 90095., Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, 757 Westwood Plaza, Ste 1638, Los Angeles, CA 90095., Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, 300 Stein Plaza, 3rd Floor, Los Angeles, CA 90095. Electronic address: .