Presentation Authors: Akbar Ashrafi*, Alessandro Tafuri, Aliasger Shakir, Luis Medina, Giovanni Cacciamani, Daniel Park, Duke Bahn, Inderbir Gill, Andre Luis de Castro Abreu, Alhambra, CA
Introduction: Recent level 1 data shows that focal therapy with vascular-targeted photodynamic treatment in Grade Group (GG) 1 prostate cancer (PCa) reduces pathological progression (PP) and radical treatment compared to active surveillance (AS) at 4 years follow-up. We aimed to compare PP-free and treatment-free survival for focal cryoablation (FC) vs AS in GG 1 (Gleason 6) PCa patients with long-term follow up.
Methods: We identified 222 consecutive patients undergoing FC (n=33) or AS (n=189) for GG 1 PCa between 2002 and 2010 from our institutional review board-approved database (HS-13-00663). All patients had at least 1 follow-up prostate biopsy (PBx) post-FC or after entering AS. All patients underwent sextant systematic transrectal ultrasound-guided PBx, performed by the same operator, using the same protocol during the same period of time. Follow-up protocols were similar for both groups and included periodic PSA, clinical exam and PBx. These cohorts started in 2002 when MRI was not available. The primary endpoint was PP-free survival and PP was defined as progression to GG â‰¥ 2 PCa on follow-up PBx. The secondary endpoint was treatment-free survival defined as freedom from any treatment after FC or starting AS. Kaplan-Meier analysis was used to evaluate PP-free and treatment-free survival.
Results: Baseline age, PSA, prostate volume, number of biopsy cores taken, number of cancer cores, cancer core length, cancer core percentage, IPSS and SHIM scores were comparable between groups (p>0.05). FC patients had significantly higher PP-free survival (p < 0.01) with a trend towards improved treatment-free survival (p=0.09) in comparison men undergoing AS. The 5-year and 10-year PP-free survival was 81% and 81% in the FC group compared to 64% and 29% in the AS group (p < 0.01) [Figure 1]. The 5-year and 10-year treatment-free survival was 72% and 72% for FC compared to 68% and 32% for AS (p=0.09), respectively.
Conclusions: Focal cryablation is associated with reduced pathological progression from Gleason 6 to Gleason 7 or higher prostate cancer when compared to active surveillance in patients with long-term follow-up.