UroToday - Single Center Experience With Third-Generation Cryosurgery for Management of Organ-Confined Prostate Cancer: Critical Evaluation of Short-Term Outcomes, Complications, and Patient Quality of Life - abstract

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Monday, 04 February 2008

Department of Urology, The Virginia Prostate Center of Eastern Virginia

Medical School, Norfolk, Va.

Technical refinements such as improved ultrasonographic localization and the

routine use of urethral warmers and small-gauge needle delivery systems have

renewed interest in cryosurgical treatment as a minimally invasive option

for selected patients with localized prostate cancer. Only three reports of

quality of life (QoL) in prostate cryoablation exist, and none report on

patients treated with third-generation cryoablative technology. We

critically examine our initial series of consecutive patients at a single

institution undergoing primary third-generation cryosurgical treatment of

localized prostate cancer with respect to treatment outcome, morbidity

profile, and QoL parameters. To our knowledge, this is the first QoL report

on third-generation cryoablation of the prostate.

We retrospectively review the records of 89 consecutive patients with median

followup of 11 months (1-32) who have undergone third-generation

cryosurgical ablation of the prostate as primary treatment for localized

prostate cancer with intention to cure. Patients were risk stratified

according to preprocedural parameters of prostate-specific antigen (PSA),

clinical stage, and Gleason score. PSA trends were recorded and treatment

effectiveness was observed using different definitions of biochemical

failure. Charts were reviewed for postprocedure complications. Quality of

life was measured prospectively using the University of California, Los

Angeles, Prostate Cancer Index as well as American Urological Association

symptom scores. We compare a percent of baseline score (%BS) for various

domains between our series of patients treated with primary cryoablation

with a series of patients undergoing brachytherapy for localized prostate

cancer.

Treatment success was defined by achievement of a PSA nadir of ?/=0.1 ng/mL

and by biochemical disease-free survival (BDFS) assessed with both a PSA

threshold of ?/=0.4 ng/dL over time and the American Society for Therapeutic

Radiology and Oncology (ASTRO) definition of three consecutive rises in PSA.

According to risk stratification, 86%, 81.5%, and 78% of low-,

intermediate-, and high-risk patients, respectively, achieved a PSA nadir of

?/=0.1 ng/mL. Overall, at 12 months follow-up, 94% of patients achieved BDFS

using ASTRO criteria while 70% achieved BDFS using a PSA threshold of ?/=0.4

ng/mL. With risk stratification, 74%, 70%, and 60% of low-, intermediate-,

and high-risk patients, respectively, achieved BDFS defined by PSA threshold

of ?/=0.4 ng/mL. Complications were rare. The response rate for Health

Related Quality of Life (HRQoL) questionnaires was 71% for cryoablation

patients and 51% for brachytherapy patients. At 12 months follow-up,

patients undergoing cryoablation on average achieved urinary and bowel

domain scores comparable to baseline, but sexual domains remained well below

baseline. When compared with a brachytherapy series with better baseline

sexual function (P = 0.04) and urinary function (P = 0.03), cryotherapy

patients experienced more negative impact on sexual function steadily for up

to 12 months (P = 0.02). Urinary function was similar between the groups

until 18 months, at which time cryoablation patients fared better (P =

0.01); this was sustained up to 24 months (P = 0.04).

Treatment success with cryosurgery varies with definition; however, our

results are comparable to other series with regard to short-term cancer

control. Complication rates in this series of third-generation cryosurgical

patients are low. QoL characteristics of third-generation cryoablation are

similar to those described in second-generation cryoablation series.

Compared with brachytherapy, cryotherapy results in less irritative and

obstructive voiding symptoms in the early post-treatment period and may

improve urinary function up to 24 months after treatment. In a small group

of older patients with baseline erectile dysfunction undergoing

cryoablation, sexual function returns to 20% of its baseline value with up

to 12 months follow-up.

Written by

Hubosky SG, Fabrizio MD, Schellhammer PF, Barone BB, Tepera CM, Given RW.

Reference

J Endourol. 2007 Dec;21(12):1521-32

doi:10.1089/end.2007.9875

PubMed Abstract

PMID:18186694