Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer

https://doi.org/10.1016/S0090-4295(02)01678-3Get rights and content

Abstract

The efficacy and safety of the long-term experience with targeted cryoablation of prostate cancer (TCAP) at a community hospital is retrospectively reviewed. A series of 590 consecutive patients who underwent TCAP as primary therapy with curative intent for localized or locally advanced prostate cancer from March 1993 to September 2001 were identified. Patients were stratified into 3 risk groups according to clinical characteristics. Biochemical disease-free survival (bDFS), post-TCAP biopsy results, and post-TCAP morbidity were calculated and presented. The mean follow-up time for all patients was 5.43 years. The percentages of patients in the low-, medium-, and high-risk groups were 15.9%, 30.3%, and 53.7%, respectively. Using a prostate-specific antigen (PSA)-based definition of biochemical failure of 0.5 ng/mL, results were as follows: (1) the 7-year actuarial bDFS for low-, medium-, and high-risk patients were 61%, 68%, and 61%, respectively; (2) the bDFS probabilities for a PSA cutoff of 1.0 ng/mL for low-, medium-, and high-risk patients were 87%, 79%, and 71%, respectively; and (3) the bDFS probabilities for low-, medium-, and high-risk patients using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition of biochemical failure (3 successive increases of PSA level) were 92%, 89%, and 89%, respectively. The rate of positive biopsy was 13%. After a positive biopsy, 32 patients underwent repeat cryoablation. For those patients who underwent repeat cryoablation, 68%, 72%, and 91% remain bDFS using definitions of 0.5 ng/mL, 1.0 ng/mL, and the ASTRO criteria, respectively, after a mean follow-up time since repeat cryoablation of 63 months. The rates of morbidity were modest, and no serious complications were observed. TCAP was shown to equal or surpass the outcome data of external-beam radiation, 3-dimensional conformal radiation, and brachytherapy. These 7-year outcome data provide compelling validation of TCAP as an efficacious treatment modality for locally confined and locally advanced prostatic carcinoma.

Section snippets

Patient selection

Between March 1993 and September 2001, 590 consecutive patients were treated at Crittenton Hospital in Rochester, Michigan. Patients were eligible for inclusion if they exhibited localized or locally advanced disease (TNM stage T1 to T3).

Procedure

The methodology used in cryosurgical ablation of the prostate has evolved significantly since its reintroduction by Onik et al.23 in 1993. The modern procedure has used the following advances: 2 freeze cycles, use of US Food and Drug Administration

Results

Retrospective analysis of 590 consecutive patients who underwent TCAP procedures with curative intent between March 1994 and September 2001 was performed. The mean age of the sample was 70.76 years, with the median age being 71.13 years. Mean follow-up time was 5.43 years, and the median follow-up time was 5.72 years.

In all, 16.4% of the sample had a presurgery PSA level <4 ng/mL, 58.9% had a PSA level of 4 to 10 ng/mL, and 24.5% had a PSA level >10 ng/mL; 41.5% of the sample had a Gleason

Discussion

Cryoablation treatment of prostate cancer is a technique that was originally introduced in the 1960s, but was abandoned because of excessive morbidity. Use of this approach was resurrected with the introduction by Onik et al.23 in 1993 of a modern transrectal ultrasound-guided percutaneous method. The treatment itself has undergone an evolution, which has stemmed from recent developments in interventional radiology, has improved cryogenic technology, and has provided a better knowledge of

Conclusion

We have shown that the 7-year efficacy rates of TCAP are comparable or superior to the rates of efficacy of all conventional radiation therapy modalities for prostate cancer. There are several other advantages to cryoablation treatment over conventional prostate cancer therapy. Cryoablation requires only a short hospital stay, with most patients being able to be discharged within 24 hours. The procedure can be applied in cases of locally advanced cancer because of the ability to extend the

Acknowledgements

We gratefully acknowledge the assistance of Mark Rose, MA, for valuable help during the preparation of the primary transcript, and Eric Bahn for chart review and data entry.

References (45)

  • W.W. Bonney et al.

    Cryosurgery in prostatic cancerelimination of local lesion

    Urology

    (1983)
  • J.P. Long et al.

    Five year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

    Urology

    (2001)
  • F. Lee et al.

    Cryosurgery for prostate cancerimproved glandular ablation by use of 6 to 8 cryoprobes

    Urology

    (1999)
  • T.R. Larson et al.

    In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes

    Urology

    (2000)
  • J.C. Bischof et al.

    Rectal protection during prostate cryosurgerydesign and characterization of an insulating probe

    Cryobiology

    (1997)
  • G.E. Hanks et al.

    Conformal external beam treatment of prostate cancer

    Urology

    (1997)
  • M.J. Zelefsky et al.

    Dose escalation with three-dimensional conformal radiation therapy affects the outcome of prostate cancer

    Int J Radiat Oncol Biol Phys

    (1998)
  • S. Dinges et al.

    High-dose rate interstitial with external beam irradiation for localized prostate cancer-results of a prospective trial

    Radiother Oncol

    (1998)
  • J.M. Crook et al.

    Percent free prostate-specific antigen after radiotherapy for prostate cancer

    Urology

    (1998)
  • J. Laverdiere et al.

    Beneficial effect of combining hormonal therapy administered prior and following external beam radiation therapy for localized prostate cancer

    Int J Radiat Oncol Biol Phys

    (1997)
  • K.A. McCammon et al.

    Comparative quality-of-life analysis after radical prostatectomy or external beam radiation for localized prostate cancer

    Urology

    (1999)
  • J.W. Robinson et al.

    Quality of life and sexuality of men with prostate cancer 3 years after cryosurgery

    Urology

    (2002)
  • Cited by (0)

    1

    Michael Chernick is a biostatistics consultant to the sponsor of this supplement.

    View full text