Prostate Cancer Whole Gland Ablation Offers Similar Oncologic Outcomes – Renal and Urology News

Primary whole gland ablation results in good intermediate- to long-term oncologic and functional outcomes for patients with low- to intermediate-risk localized prostate cancer, according to real-world data.

Investigators performed a systematic review and meta-analysis of 14 mostly retrospective studies on cryoablation and 15 studies on high-intensity focused ultrasound (HIFU) with a median follow-up of 72 months that were published from 2000 to 2021.

At 10 years, rates of biochemical recurrence-free, cancer-specific, overall, recurrence-free, and metastasis-free survival were 58%, 96%, 63%, 71-79%, and 84%, respectively, Thomas J. Polascik, MD, of Duke Cancer Institute and Duke University Medical Centre in Durham, North Carolina, and colleagues reported in European Urology. They noted that 36.5% of patients had neoadjuvant androgen deprivation therapy (ADT).

Erectile function was preserved in 37% of patients. At 1 year, 97.4% to 98.8% of men were continent and did not require pads, and 96% overall maintained urinary continence. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively.

According to expert reviewers, whole gland ablation is a good option for patients with low- to intermediate-risk disease who are ineligible for radiation, surgery, or focal ablation therapy.

They recommended PSA monitoring every 3 to 6 months for the first 5 years and annually thereafter. They also strongly recommended mpMRI at 6 and 12 months after ablation to gauge treatment success.

“The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa,” Dr Polascik’s team concluded. “When compared with other existing treatment modalities for [prostate cancer], these ablative therapies provide nearly equivalent intermediate- to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting.”

Phoenix criteria (PSA nadir plus 2 ng/mL) was preferred to diagnose biochemical recurrence. To identify biopsy targets, the experts encouraged mpMRI. Tissue sampling should include target lesions and preferably systematic template sites and the seminal vesicle, they stated. If the clinician suspects metastasis, the experts recommend PSMA PET CT (18F or 68-Ga) for disease staging.