Oncological Assessment of Patients with Prostate Cancer Treated by last Generation Primary Cryotherapy

Abstract

Introduction. About 94% of the patients with prostate cancer at a localized stage benefit of minimally invasive treatments nowadays, with results comparable to radical prostate resection – a method still considered as the gold standard [1,2]. Prostate cryotherapy is successfully used in patients with prostate cancer, either as a primary treatment or second recourse (after failure of radiotherapy).

Material and method. A prospective study included 556 patients diagnosed with prostate adenocarcinoma, treated by US-guided transperineal primary prostatic cryotherapy at the Clinical Institute of Urology and Renal Transplantation of Cluj- Napoca and Lukmed Clinic between October 2006–July 2010. The Oncura 200 Golden SeedNet 2 system was used. Patient follow-up included clinical examinations and prostate specific antigen (PSA) determinations at 1, 2, 3, 6, 9, 12, 18, 24, 30, 36, 42, 48, and 54 months. Biochemical recurrence was established after three consecutive incresed levels of PSA. A statistical analysis aimed at investigating whether the Gleason score, tumoral stage, preoperative PSA were prognostic factors of biochemical recurrence.

Results. According to D’Amico’s classification, the patients included in the study were: 397 (71.4%) with low risk, 97 patients (17.4%) with moderate risk, and 62 (11.2%) with high risk. The mean preoperative PSA value (standard deviation) according to the risk group was 5.67 (1.44) ng/ml for low risk, 8.18 (3.08) ng/ml for moderate risk and 12.17 (6.43) ng/ml for the high risk. Survival rates without biochemical recurrence was 89.55 %, 72.92% and 63.94% in the low, moderate and high risk patients, respectively. The result of the statistical analysis (chi square test) evidenced a statistically significant relationship between Gleason score, tumoral stage, preoperative PSA and the post-cryotherapy biochemical recurrence.

Conclusions. Last generation prostate cryotherapy is an efficient therapeutic technique for prostate cancer, with a survival rate without recurrence of 89.55 %, 72.92%, 63.94% in the low, moderate and high risk patients, respectively. The ideal candidates for prostate cryotherapy are patients at low risk. Maximal tissular destruction after cryotherapy, as evidenced by the lowest PSA level was recorded after a mean time period of three months after the operation.