Oncologic outcomes and morbidity in patients with prostate cancer underwent cryotherapy

Introduction & Objectives Cryotherapy(CTH) is one of treatment options for the prostate cancer (PCa) whose use has increased.The considerable technological improvements in CTH including gas-driven miniaturized equipment, ultrasonographic ice-ball monitoring, and the use of thermal sensors have allowed more efficient freezing of the prostate gland.These improvements have led to decreased morbidity and a resurgence of CTH for primary treatment of PCa.The aim of the current paper is to evaluate oncologic outcomes and morbidity in patients underwent CTH for prostate cancer. Material & Methods from October 2006 to March 2012 a total of 556 patients with PCa were treated; mean age was 65.9 ± 15.0 (range 50- 88).According to the D’Amico criteria, 62 (11,2%) had high-risk PCa, 97 (17.4%) intermediate-risk and 397 (71.4%) low-risk PCa.In order to achieve a “downsizing” of the prostate volume below 50 gr, 123 patients (22.1%) received a neoajuvant androgen deprivation therapy for 6 months.To all patients pre-operatively were administered IPSS and IIEF-5 questionnaires.The minimun follow-up was of 12 months.Post-operatively patients were followed with: monthly serum PSA determinations for 6 months and then every 3 months; prostate biopsies (12 cores) between 6 and 12 months; administration of IPSS and IIEF-5 questionnaires at 6 and 12 months. Results Mean PSA at study entry was 15.7 ng/ml (range 6.2- 25.1). 477 patients(85.8%) had a T1c clinical stage, 57 (10.2%) a T2a, 12 (2.2%) a T2b and 10 (1.8%) a T2c clinical stage. Post-operative complications recorded were: perineal ecchymosis(59.9%), LUTS (33.1%), scrotal ecchymosis(27.2%), Urinary Tract Infections(UTI)(9.7%), rectal and pelvic pain (9.2%), scrotal swelling(9.2%), urethral sludging(7%), haematuria(5.6%), penis paresthesia(3.6%), urethral stricture(3.4%), urinary incontinence(2.9%), urinary fistula(0.2%). The median post-CTH PSA nadir achieved was 0.12 ng/ml. Biochemical failure(BF) ,according to the ASTRO definition, was of 16.2%. BF stratified according to D’Amico risk groupings resulted of 10.5% in the lowrisk group, 27.1% in the intermediate-risk and 36.1% in the high-risk group. Prostate biopsy following primary CTH resulted positive in 10.2% patients, and according to D’amico risk groupings, biopsy positivity resulted of 4.6% in the low-risk group, 19.8% in the intermediate-risk group and 31.1% in the high-risk group. Pre-operatively 101 patients (18.2%) showed a severe ED, 204(36.7%) a moderate ED, 192(34.5%) a mild ED and in 59(10.6%) ED resulted absent. At 6 months 360 (64.7%) reported a severe ED, 116(20.9%) a moderate ED and in 80(14.4%) ED resulted mild. IIEF-5 scores at 12 months showed a severe ED in 263(47.3%) patients, moderate in 135(24.3%), mild in 147(26.4%) and absent in 11(2%). Conclusions CTH for PCa in our experience shows a reasonably low level of complications except for ED. The oncologic outcomes currently available from our study show encouraging results for patients with low and intermediate risk. The applicability of CTH in high-risk patients is likely to be reserved for selected cases and/or as salvage treatment. Preliminary results show that CTH is a promising minimally invasive treatment, but it continue to be plagued of long-term follow-up assessing oncologic. Further clinical trials with these purposes are still needed before solid conclusions can be drawn.