Category: MIS Image Guided/ Focal-cryo/RFA/HIFU: Prostate

MP23-16 - Active surveillance prior to cryotherapy is associated with increased risk of post-treatment positive biopsy and progression to salvage treatment relative to cryotherapy without delay in organ-confined prostate cancer

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Many cases of prostate cancer have a prolonged course and may be managed conservatively. Thus, active surveillance (AS), which employs routine screenings, is often used to prevent or delay treatment and its associated side effects. Definitive treatment, including cryotherapy, is used in the event of disease progression detected on AS.  We sought to determine whether AS prior to cryotherapy results in inferior oncological control relative to cryotherapy without delay, potentially as a result of a “missed opportunity”for treatment.

Methods :

Patients who underwent primary cryotherapy for prostate cancer were identified from our IRB-approved database. Cohort characteristics, and oncological outcomes and predictors, between the group that underwent AS prior to cryotherapy and the group that underwent cryotherapy without delay, were compared using descriptive statistics, Kaplan-Meier and log-rank tests, and Cox regression analyses.

Results :

439 patients in the database underwent AS; 28 of whom underwent eventual cryotherapy. 272 patients underwent cryotherapy without delay. Median follow-up from cryotherapy to most recent office visit was 30 months.  There was no difference in preoperative Gleason scores (p=0.88), PSA levels (p=0.32), or age at cryotherapy (p=0.69) between the cryotherapy without delay and AS prior to cryotherapy cohorts. There was no difference in biochemical recurrence (PSA nadir + 2 ng/ml) (log-rank p=0.37), metastasis (p=0.46) or overall survival (p=0.48) between the two groups.  AS prior to cryotherapy was associated with an increased risk of positive biopsy (p=0.02) and increased risk of progression to salvage treatment (p=0.01) following primary cryotherapy. On multivariate analysis, AS prior to cryotherapy was a predictor of post-treatment positive biopsy (hazard ratio [HR] 2.80, confidence interval [CI] 1.16–6.75) and progression to salvage treatment (HR 3.82, CI 1.47–9.88).

Conclusions :

Patients with organ-confined prostate cancer who underwent AS prior to cryotherapy had a greater risk for post-cryotherapy positive biopsy and progression to salvage treatment relative those who underwent cryotherapy without delay.

Glenn Werneburg

Stony Brook, New York

Amanda Le Sueur

Mineola, New York

Jose Salcedo

Mineola, New York

Roy Gildersleeve

Mineola, New York

Aaron Katz

Chairman of Urology
NYU Winthrop hospital
Mineola, New York

Dr. Aaron E katz M.D. is the chairman of urology At NYU Winthrop University Hospital. He is a pioneer in the area of prostate cancer treatment using percutaneous guided cryotherapy. He has performed over 3000 of these procedures both in the primary , salvage and focal setting. He also has interests in holistic therapies and has a large database of patients on active holistic surveillance using dietary strategies and vitamin supplements to reduce or prevent PSA progression In Maine with early-stage prostate cancer. He has published over 200 scientific articles and has lectured nationally and internationally on the role of minimally invasive therapies for prostate cancer.
Dr. katz obtained his urology residency training in Brooklyn and then completed a urologic oncology fellowship at Columbia medical center where he spent most of his caree and artained endowed professorahip . In the last six years he has taken on the leadership role as chairman of urology at NYU Winthrop in Mineola New York. He sees patients in Garden City Long Island as well as in Manhattan.