Faculty Collaboration Database

Primary Cryotherapy for High-Grade Clinically Localized Prostate Cancer: Oncologic and Functional Outcomes from the COLD Registry. J Endourol 2016 Jan;30(1):43-8

Date

09/29/2015

Pubmed ID

26414656

DOI

10.1089/end.2015.0403

Scopus ID

2-s2.0-84954357932 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

OBJECTIVE: To evaluate the oncological and functional outcomes of primary cryotherapy in men with clinically localized, high-grade prostate cancer.

SUBJECTS AND METHODS: We included all men with biopsy Gleason score ≥8, localized (cT1-2) disease with a serum prostate-specific antigen (PSA) ≤50 ng/mL from the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression free survival (BPFS) as defined by the Phoenix criteria (nadir PSA +2 ng/mL). Secondary outcomes of continence (defined as strictly no leak) and potency (able to have intercourse) were patient reported. Factors influencing BPFS were evaluated individually using Kaplan Meier and in a multivariate model using Cox regression.

RESULTS: Altogether, 300 men were included for analysis. The median follow-up was 18.2 months (mean 28.4) and median BPFS was 69.8 months. Based on Kaplan-Meier analysis, the estimated 2- and 5-year BPFS rate was 77.2% and 59.1%, respectively. Neoadjuvant hormonal therapy was administered to 41% of men and this tended to occur in men with larger prostates, likely as a technical consideration for downsizing before cryosurgery. At multivariate analysis, the presence of Gleason score 9 or 10 (Hazard Ratio [HR] 1.9) and a posttreatment PSA nadir of ≥0.4 ng/mL (HR 5.7) were the only significant variables associated with biochemical progression using Cox regression. Complete continence was noted in 90.5% of men and potency in 17% of men at the 12-month follow-up. The incidence of rectourethral fistulae and urinary retention requiring intervention beyond temporary catheterization was 1.3% and 3.3%, respectively.

CONCLUSION: Primary cryotherapy appears to be effective and safe in the community setting for high-grade, clinically localized prostate cancer in the short term.

Author List

Tay KJ, Polascik TJ, Elshafei A, Cher ML, Given RW, Mouraviev V, Ross AE, Jones JS

Author

Test W. User test user title in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Biopsy
Cryotherapy
Disease Progression
Disease-Free Survival
Humans
Kaplan-Meier Estimate
Male
Neoplasm Grading
Postoperative Complications
Proportional Hazards Models
Prostate-Specific Antigen
Prostatic Neoplasms
Rectal Fistula
Registries
Urethral Diseases
Urinary Retention