Nonetheless, a higher risk of genito-urinary and rectal toxicity after prostatectomy or EBRT should be taken into account when treating this population.2-3 In this perspective, focal treatment (FT) could provide a valid active treatment by minimizing side effects.
We retrospectively collected data from 110 patients who underwent focal or hemiablative cryoablation (Partial gland cryoablation – PGC) from February 2013 to January 2021. Our Institutional cryoablation protocol included patients with EAU low-to intermediate risk unilateral PCa who refused or were not eligible for radical treatments, low-risk PCa who refused active surveillance (AS) or other radical treatments.4 Specifically, this cohort included patients with more than 70 years, good performance status, and strongly motivated to undergo active treatment. Our cohort demonstrated that PGC showed 68.5% for 5-year biochemical recurrence survival and 71.5% for clinical recurrence.
According to Clavien-Dindo classification, no >3a complications occurred during post-operative follow-up.5
Two patients required a further transurethral resection of the prostate (Clavien-Dindo 3a complication: 1.8%), while urge incontinence persisted only in two of them after six months from PGC. No follow-up data regarding sexual function were available.
Our clinical experience taught us how more and more fit and well-informed older patients required active treatment since striking regional differences in the uptake of AS must be taken into consideration. On the other side, the number of older patients with advanced prostate cancer will rapidly increase in the next few years. In our opinion, active treatment must be early and mandatory, with particular regard to the evaluation of health status and prevention of side effects, both prior to and during treatment.
With this in mind, we stressed the need for dedicated guidelines for PCa in older patients and more prospective well-designed studies in this setting.
Written by:
- Oscar Selvaggio, MD, Urology Department and Renal Transplantation, University of Foggia, Italy
- Marco Finati, MD, Urology Department and Renal Transplantation, University of Foggia, Italy
- Professor Giuseppe Carrieri, Chairman and Residency Program Director, Department of Urology and Renal Transplantation, University of Foggia, Italy
- Boyle HJ, Alibhai S, Decoster L, Efstathiou E, Fizazi K, Mottet N, Oudard S, Payne H, Prentice M, Puts M, Aapro M, Droz JP. Updated recommendations of the International Society of Geriatric Oncology on prostate cancer management in older patients. Eur J Cancer. 2019 Jul;116:116-136. doi: 10.1016/j.ejca.2019.04.031.
- Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Potosky AL, Stanford JL, Stroup AM, Van Horn RL, Penson DF. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013 Jan 31;368(5):436-45. doi: 10.1056/NEJMoa1209978.
- Marotte D, Chand-Fouche ME, Boulahssass R, Hannoun-Levi JM. Irradiation of localized prostate cancer in the elderly: A systematic literature review. Clin Transl Radiat Oncol. 2022 Apr 20;35:1-8. doi: 10.1016/j.ctro.2022.04.006.
- Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021;79(2):243-262. doi:10.1016/j.eururo.2020.09.042
- Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-96. doi: 10.1097/SLA.0b013e3181b13ca2.