To assess the safety and oncological efficacy of percutaneous MR-guided whole-gland prostate cancer (PCa) cryoablation (CA).
Between July 2009 and January 2018, 30 patients (mean age 72.9 ± 5. 13 years) with histologically-proven, organ-confined (≤ T 2cN0M0), predominantly low/intermediate-risk PCa (median Gleason score 7; mean PSA 6.05 ± 3.74 ng ml-1 ) underwent MR-guided whole-gland CA. Patients were selected on the basis of prior pelvic radiotherapy (n = 16; 12 for previous PCa), or contra indication/refusal of surgery or radiotherapy. Complications, local progression-free-survival (LPFS) and overall-survival (OS) were retrospectively investigated.
Eighteen [60%] patients reported procedure-related complications: 5/18 [28%] needed surgical/interventional treatments and 13 [72%] conservative or pharmacological treatment. Eleven [73%] complications were noted in the first 15 patients and 7 [47%] in the last 15 patients (p = 0.26). Mean nadir PSA was 0.24 ± 1.5 ng ml-1 (mean follow-up 3.8 years; range: 2 - 2915 days). Seven [23%] patients developed histologically proven local progression (mean time to recurrence 775 days, range: 172 - 2014). Mean clinical follow-up was 3.8 years (range 1 - 2915 days). LPFS was 92.0%, 75.7 and 69.4 % at 1-, 3- and 5 year follow-up, respectively. For patients with prior radiotherapy, LPFS was 100%, 80%, and 80 % at 1-, 3- and 5 year follow-up. OS was 100%, 94.4 and 88.5 % at 1-, 3- and 5 year follow-up respectively, with no patients dying from PCa.
Whole-gland PCa CA offers good oncological efficacy, particularly in post-radiotherapy cases. Although the complication rate is significant, the majority is minor and is managed with conservative or pharmacologic management.
MRI-guided whole-gland prostate cancer cryoablation offers good oncological efficacy, particularly in post-radiotherapy cases with a contained complication rate.
The British journal of radiology. 2019 Mar 08 [Epub ahead of print]
Marini Pierre DE, Cazzato Roberto Luigi, Garnon Julien, Tricard Thibault, Koch Guillaume, Tsoumakidou Georgia, Ramamurthy Nitin, Lang Hervé, Gangi Afshin
1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France., 2 Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France., 4 Department of Radiology, Norfolk and Norwich University Hospital , Norwich , UK.