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. 2023 May;55(5):1125-1132.
doi: 10.1007/s11255-023-03519-y. Epub 2023 Feb 21.

Treatment of localized prostate cancer in elderly patients: the role of partial cryoablation

Oscar Selvaggio  1 , Marco Finati  2   3 , Ugo Giovanni Falagario  1 , Giovanni Silecchia  4 , Marco Recchia  1 , Andrea Alberto Checchia  1 , Paola Milillo  5 , Francesca Sanguedolce  6 , Luca Cindolo  7 , Gian Maria Busetto  1 , Carlo Bettocchi  1 , Luigi Cormio  1   4 , Giuseppe Carrieri  1
Affiliations

Treatment of localized prostate cancer in elderly patients: the role of partial cryoablation

Oscar Selvaggio et al. Int Urol Nephrol. 2023 May.

Abstract

Purpose: To evaluate oncological outcomes of partial gland cryoablation (PGC) for localized prostate cancer (PCa) in a cohort of elderly patients who required an active treatment.

Methods: Data from 110 consecutive patients treated with PGC for localized PCa were collected. All patients underwent the same standardized follow-up with serum-PSA level and digital rectal examination. Prostate MRI and eventual re-biopsy were performed at twelve months after cryotherapy or in case of suspicion of recurrence. Biochemical recurrence was defined according to Phoenix criteria (PSA nadir + 2 ng/ml). Kaplan-Meier curves and Multivariable Cox Regression analyses were used to predict disease progression, biochemical recurrence- (BCS) and additional treatment-free survival (TFS).

Results: Median age was 75 years (IQR 70-79). PGC was performed in 54 (49.1%) patients with low-risk PCa, 42 (38.1%) with intermediate risk and 14 (12.8%) high risk. At a median follow-up of 36 months, we recorded a BCS and TFS of 75 and 81%, respectively. At 5 years, BCS was 68.5% and CRS 71.5%. High-risk prostate cancer was associated with lower TFS and BCS curves when compared with low-risk group (all p values < .03). A PSA reduction < 50% between preoperative level and nadir resulted as an independent failure predictor for all outcomes evaluated (all p values < .01). Age was not associated with worse outcomes.

Conclusions: PGC could be a valid treatment for low- to intermediate PCa in elderly patients, when a curative approach is suitable in terms of life expectancy and quality of life.

Keywords: Cryoablation; Focal therapy; Geriatric oncology; Minimally invasive surgery; Prostate cancer.

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Conflict of interest statement

The other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Location of the 18 cores in coronal projection. Location of the 18 cores in coronal projection. Black points represent the sextant cores, blue points the standard lateral peripheral cores, green points the paramedian peripheral cores and red points the additional lateral peripheral cores. Source: https://doi.org/10.1007/s00345-012-0989-8
Fig. 2
Fig. 2
Kaplan–Meier curves addressing biochemical recurrence, stratified for EAU PCa risk groups [1]
Fig. 3
Fig. 3
Kaplan–Meier curves addressing additional treatment-free survival, stratified for EAU PCa risk groups [1]
Fig. 4
Fig. 4
Kaplan–Meier curves addressing disease progression-free survival, stratified for EAU PCa risk groups [1]
See this image and copyright information in PMC

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