P-69
Prostate cryoablation as primary treatment of prostate cancer: oncological results with followup biopsy Galosi A.B. (1),Parri G. (1), Montironi R. (2),Lugnani F. (3),Cantoro D.(1), Muzzonigro G. (1)
Institute of Urology, (2) Institute of Pathological Anatomy and Histopathology, Polytechnic University of Marche Region, Torrette United Hospitals, Ancona, (3) International Society of Cryosurgery, Villa Salus, Trieste, Italy
(1)
Introduction: We report our experience assessing cancer control after 5 yrs median follow-up. Methods: 95 pts (73 yrs ±6) consecutively treated with cryoablation. Clinical stage were: 51 cT1-2a, 23 cT2b-c, 21 cT3a (24%), cN0 M0; PSA was 11.7 ng/ml ±9.1, biopsy Gleason Score was 5-6 in 59 and 7-9 in 36. 47 patients were >73 yrs old, 46 (48%) had significant co-morbidity factors, and 23 (24%) patients refused surgery or RT. 96% underwent preoperative hormonal therapy (HT). Treatment failure were considered: PSA >1.0 ng/ml or cancer in follow-up biopsies or distant mets. After 12-24 months or if PSA was >1, the residual prostate was studied using ultrasound and biopsies, that were 8 -14 cores per session. The pathologist described the presence of cancer tissue, fibrosis, and normal tissue and reported as percentage the amount of each features in any single specimen. Results: After a median f-u of 70 mts (6-120): 80/95 had > 2 biopsy session after treatmenta (1 to 5, mean 2 bx set per patient were perfomed). 3/95 underwent repeated cryoablation. 6 pts died, 1 with disease progression, 5 without disease progression. 50/85 (58.82%) are disease free with negative biopsy and stable PSA (<1.0). Overall DFS was 61.1% (58/95). According risk group, DFS was 87.5%, 67.9% and 39.5% in the low, medium and high risk group respectively. Treatment failure was observed in 37/95 (38.9%): PSA failure in 15.8%, positive biopsy in 21.1%, distant mets in 2/95 (2.1%). However, 8 of 37 (21%) failure pts were observed only and not treated, due to PSA above 1 ng/ml without progression and negative biopsies. Normal prostate tissue can be detected in 55% of pts in f-u biopsies, however the variation in the amount of normal tissue was great and related to PSA nadir and pre-operative prostate volume. Stress incontinence was observed in 3%. Conclusion: In low risk pts, the 5-yrs cancer control rate is 87% using last generation of cryoablation system. New technology reduces morbidity if compared to hystorical series and improves efficacy through more precise and homogeneous ablation: however normal prostate tissue can be detected in follow-up biopsies.