INTRODUCTION: Prostate cryoablation was developed with the intent of maximizing effectiveness while minimizing the morbidity of treating clinically localized prostate cancer. Our focus was to determine Kaplan-Meier (KM) biochemical recurrence-free survival (BRFS) estimates and how they might be affected by neoadjuvant hormone therapy, race, D’Amico risk group, and prostate volume.
METHODS: We retrospectively analyzed data from 190 patients receiving cryoablation for the primary treatment of T1 to T3 prostate cancer from 2003 to 2009. All patients underwent whole-gland prostate cryoablation by a single surgeon using the Cryocare CS System (HealthTronics; Austin, TX, USA). Patients received a prostate-specific antigen and digital rectal examination at 1, 3, 6, 9, 12, 18, 24, and 30 months after surgery. A PSA nadir of ≤ 0.1 ng/mL was used to define treatment success. KM BRFS curves were plotted overall and by subanalysis variable and compared using the log-rank test. Univariate Cox proportional hazard regression models were used to describe the effect of measured variables on risk of biochemical recurrence.
RESULTS: The mean follow-up was 27 months. A total of 153 patients (81%) reached the treatment goal of PSA nadir ≤ 0.1 ng/mL. Using a nadir + 2 ng/mL failure definition, BRFS rates were 94% and 85% for 1 year and 3 years, respectively. High D’Amico risk significantly predicted biochemical recurrence (hazard ratio [HR] = 3.65; P = .045). African American men had a nonsignificant trend toward increased risk (HR= 1.91; P = .12). BRFS did not differ when comparing men who did or did not receive hormone therapy (log-rank test: P = .57) or men with prostate size < 40 g vs ≥ 40 g (P = .72). The majority of complications were minor, with a rate of 12%.
CONCLUSIONS: Although neoadjuvant hormone therapy and prostate volume at the time of surgery were not statistically associated with BRFS, race approached significance and high D’Amico risk group was significant. Our short-term results justify the continuing use of cryosurgery for the management of localized prostate cancer.
KEYWORDS: Cryotherapy; Neoadjuvant Hormone Therapy; Prostate; Prostate Cancer; Prostate Cryoablation
CORRESPONDENCE: LCDR James C. Nederostek, MD, Department of Urology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA ().
CITATION: Urotoday Int J. 2011 Aug;4(4):art48. doi:10.3834/uij.1944-5784.2011.08.04
ABBREVIATIONS AND ACRONYMS: ASTRO, American Society for Therapeutic Radiology and Oncology; BRFS, biochemical recurrence-free survival; CT, computed tomography; KM, Kaplan-Meier; PSA, prostate-specific antigen; RTOG, Radiation Therapy Oncology Group.