Focal cryotherapy for localized prostate cancer: a report from the national Cryo On-Line Database (COLD) Registry

Abstract

Study Type - Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Selective destruction of targeted prostate tissue is now technically feasible. Much has been theorized but little is known about the proper patient selection or treatment outcomes to determine if this organ preserving approach to prostate cancer has merit for further study and diffusion into wider practice. Herein we present the largest retrospective registry report of men treated with sub-total prostate cryotherapy in order to begin to understand how this treatment is being applied despite the paucity of data.

Objectives: • To identify recent trends in focal cryotherapy from a prospectively maintained treatment registry. • To describe treatment outcomes after uncontrolled application of focally ablative techniques within community practice.

Materials and methods: • We conducted an analysis of the COLD Registry to identify patients treated with partial gland prostate cryoablation between 1997 and 2007. • Preoperative characteristics and postoperative cancer-specific and functional outcomes were assembled for analysis.

Results: • The COLD Registry contained information for 5853 patients and focal cryotherapy was the codified procedure in 1160 patients (19.8%). • A dramatic increase in focal treatments was observed, from 46 in 1999 to 567 in 2005 (P < 0.01). • The biochemical recurrence-free rate (ASTRO definition) at 36 months was 75.7%. • Prostate biopsy, performed in 164/1160 of patients (14.1%), was positive in 43 (26.3%) of those suspected of cancer recurrence, but in only 3.7% (43/1160) of treated patients. • Urinary continence (defined as use of 0 pads) was 98.4%. Maintenance of spontaneous erections was 58.1%. Prolonged urinary retention (>30 days) occurred in six (1.1%) patients. Rectourethral fistula was observed in one (0.1%) patient.

Conclusions: • Focal cryoablation is increasingly used for selected patients with prostate cancer. • Oncological efficacy in the present series appears similar to that of whole-gland cryoablation. • The impact of focal cryoablation on urinary, sexual and bowel function appears to be less than that of radical therapies, although preservation of sexual function is not as high as might be expected.