Category: MIS Image Guided/ Focal-cryo/RFA/HIFU: Prostate
Introduction & Objective :
Focaltherapy in the management of localized prostate cancer (PCa) has gained in interest due to its promising efficiency with reduced side-effect profile. The objective of our study was to evaluate the oncological results of focal cryoablation for localised PCa.
Treatment-naïve PCa patients with localized disease, who underwent focal cryoablation as a primary treatment for PCa at a single high-volume European Centre between January 2009 and November 2016 were included in the study. Pre-biopsy MRI was performed to all the patients and PCa diagnosis was confirmed by transperineal mapping biopsy. Patients were followed-up by PSA every 3 months, prostate MRI every 6 months, and transperineal mapping biopsies according to MRI results or at least once per year when no suspicious lesion was detected. Treatment failure or PCa recurrence was considered when any cancerous tissue was detected on the biopsy sample.
107 patients were included in the study. All the patients had unilateral disease with Gleason 6 diagnosed to 82 (76.6%) cases and Gleason 7 (3+4) to 25 (23.4%) cases. Mean pre-operative PSA was 7.06 ng/ml (SD 2.81). Mean follow-up was 64.0 months (SD 22.4). PCa was respectively detected to 37 (34.6%) and 30 (28%) patients within and outside the treated area during the follow-up period. Mean time was 23.0 (SD 18.0) and 25.7 (SD 18.0) months to diagnose failure and recurrence, respectively (p=0.342). Mean PSA decline after the focal therapy was 65.6% (SD 20.0) in cancer-free cases, 50.7% (SD 30.2) in patients with treatment failure, and 42.8% (30.2) in PCa recurrent cases (all p>0.05). On univariate analysis only pre-operative Gleason score was associated with treatment failure: 13/37 (35.1%) cases of failure was diagnosed pre-operatively with Gleason 7, while just 12/70 (17.2%) cases of cancer-free and recurrent cases had Gleason 7 disease (p=0.036). On multivariate analysis using forward stepwise entering of covariates, Gleason score was the only independent predictor of treatment failure (HR 2.62, CI (95%) 1.05-6.55, p=0.040)
Focal cryoablation of the prostate is a promising technique with acceptable middle-term oncological outcomes. Patients with Gleason 7 pattern should be selected with caution and treated more aggressively due to higher risk of treatment failure.
Arnas Bakavicius– Clinical Fellow, L'Institut Mutualiste Montsouris, Vilnius, Vilniaus Apskritis, Lithuania
Eric Barret– staff, Institut Montsouris, Paris, Ile-de-France, France
Marc Galiano– , Paris, Ile-de-France, France
Alexandre Ingels– , Paris, Ile-de-France, France
François Rozet– , Paris, Ile-de-France, France
Rafael Sanchez-Salas– L'Institut Mutualiste Montsouris, Paris, Ile-de-France, France
Xavier Cathelineau– Professor, Chair Department of Urology, Institut Montsouris, Paris, Paris, Ile-de-France, France
L'Institut Mutualiste Montsouris
Vilnius, Vilniaus Apskritis, Lithuania
Dr. Arnas Bakavicius is urologist from Lithuania with academic background in Lithuania and France. Dr. Bakavicius graduated from Vilnius University (Vilnius, Lithuania), followed by clinical fellowship in robotics & minimally invasive surgery at L'Institut Mutualiste Montsouris (Paris, France). Main area of interest - uro-oncology. Dr. Bakavicius is also a PhD candidate, invesrtigating diagnostic molecular markers in prostate cancer.