Focal Cryotherapy in the Treatment of Localized Prostate Cancer

Huy D. Nguyen, BS; Bryan J. Allen, MD; Julio M. Pow-Sang, MD

Disclosures

Cancer Control. 2013;20(3):177-180. 

In This Article

Reported Series on Focal Cryotherapy

Onik et al[16] first reported on the use of cryotherapy as focal therapy. They reported on 9 patients with an average follow-up of 3 years. All of the patients had a stable PSA at the time of reporting, and 7 of the 9 previously potent men maintained erectile function satisfactory for penetration. Three patients underwent bilateral gland ablation with an attempt to spare one of the neurovascular bundles, 1 patient had the area of the tumor ablated with a margin around the tumor, and the remaining patients underwent hemi-ablation. A follow-up report included 48 patients with a minimum follow-up of 2 years and an average follow-up of 4.5 years.[17] Forty-five of 48 men had a stable PSA according to the ASTRO definition. Potency was maintained in 36 of 40 men (90%) who were initially potent. All patients remained continent (Table).

The Cryosurgery On-Line Database (COLD) registry provides one of the largest data sets for patients treated with cryotherapy.[18] A total of 1,160 patients were treated with focal therapy. The authors noted that in 1999, focal cryosurgery represented 2.1% of the treatments used for patients entered into the database. By 2007, the percentage had increased to 38.2%. Of the patients treated with focal cryotherapy, 47%, 41%, and 12% were stratified into low-, intermediate-, and high-risk groups, respectively. The 3-year biochemical-free survival was 74.7%. This is comparable to patients in the COLD database treated with whole gland cryotherapy.[18] Maintenance of spontaneous erections and urinary continence was 58.1% and 98.4%, respectively.

Bahn et al[19] reported on 73 patients treated with focal cryotherapy. The mean follow-up was 3.7 years. Using the ASTRO definition for PSA failure, 75% of patients were free of biochemical recurrence. Potency was preserved in 86% of patients, and 100% of the patients maintained continence.

Lambert et al[20] reported on a cohort of 25 patients treated with focal cryotherapy. PSA failure was defined as nadir + 2 (Phoenix definition) or a decrease in the PSA of less than 50% of the pretreatment PSA value. At a mean follow-up of 2.3 years, the biochemical-free survival rate was 85%. Erectile function was preserved in 71% of the patients in this study, and no patients experienced worsening of their urinary symptoms.

Ellis et al[21] reported on 60 men treated with focal cryotherapy, with a mean follow-up of 1.3 years. The biochemical-free survival rate was 80.4%, and the potency rate was 70.6% at 12-month follow-up. The incontinence rate was 3.6%; however, no patients required the use of absorbent pads for protection.

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