Focal Cryotherapy for Clinically Unilateral, Low-Intermediate Risk Prostate Cancer in 73 Men with a Median Follow-Up of 3.7 Years
Menée entre 2002 et 2011 sur 73 patients atteints d'un cancer de la prostate unilatéral à risque faible ou intermédiaire (durée médiane de suivi : 3,7 ans), cette étude évalue les résultats oncologiques et fonctionnels d'une cryothérapie focale
Background : Evolution of cryotherapy for prostate cancer is likely to result in parenchyma-sparing modifications adjacent to the urethra and neurovascular bundle. Results of initial series of focal therapy to minimize cryosurgery-related morbidity without compromising oncologic control have been encouraging, but limited in short-term outcomes. Objective : To retrospectively report (1) median 3.7-yr follow-up experience of primary focal cryotherapy for clinically unilateral prostate cancer with oncologic and functional outcomes, and (2) matched-pair analysis with contemporaneous patients undergoing radical prostatectomy (RP). Design, setting, and participants : Over 8.5 yr (September 2002 to March 2011), focal cryoablation (defined as ablation of one lobe) was performed in 73 carefully selected patients with biopsy-proven, clinically unilateral, low-intermediate risk prostate cancer. All patients underwent transrectal ultrasound (TRUS) and Doppler-guided sextant and targeted biopsies at entry. Outcome measurements and statistical analysis : Post-therapy follow-up included measuring prostate-specific antigen (PSA) level every 3–6 mo; TRUS biopsies at 6–12 mo and yearly, as indicated; and validated symptom questionnaires. Matched-pair analysis compared oncologic outcomes of focal cryotherapy and RP (matched for age, PSA, clinical stage, and biopsy Gleason score). Results and limitations : Complete follow-up was available in 70 patients (median follow-up: 3.7 yr; range: 1–8.5 yr). No patient died or developed metastases. Precryotherapy mean PSA was 5.9 ng/ml and Gleason score was 6 (n = 30) or 7 (n = 43). Postcryotherapy mean PSA was 1.6 ng/ml (70% reduction compared to precryotherapy; p < 0.001). Of 48 patients undergoing postcryotherapy biopsy, 36 (75%) had negative biopsies; positive biopsy for cancer (n = 12) occurred in the untreated contralateral (n = 11) or treated ipsilateral lobe (n = 1). Complete continence (no pads) and potency sufficient for intercourse were documented in 100% and 86% of patients, respectively. Matched-pair comparison of focal cryotherapy and RP revealed similar oncologic outcome, defined as needing salvage treatment. Conclusions : Primary focal cryoablation for low-intermediate risk unilateral cancer affords encouraging oncologic and functional outcomes over a median 3.7-yr follow-up. Close surveillance with follow-up whole-gland biopsies is mandatory.