Cryoablation for locally advanced clinical stage T3 prostate cancer: a report from the Cryo-On-Line Database (COLD) Registry
Ward JF, Diblasio CJ, Williams C, Given R, Jones JS. BJU Int. 2013 Sep 25. doi: 10.1111/bju.12476. [Epub ahead of print]


Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.


OBJECTIVE: To assess the oncologic and functional outcomes of primary prostate cryoablation for men with clinical stage T3 prostate cancer.

INTRODUCTION: Radical prostatectomy or external beam radiotherapy are the standard treatments for locally advanced clinical stage T3 (cT3) prostate cancer, but some patients opt for nonextirpative prostate cryoablation instead.

PATIENTS AND METHODS: The Cryo-On-Line Database (COLD) Registry was queried to identify patients with cT3 prostate cancer treated with whole-gland cryoablation (n = 366). We assessed biochemical disease-free survival (bDFS) using the Phoenix definition and determined reported rates of urinary incontinence and retention, sexual activity, and rectourethral fistulization following treatment. Patients were subsequently assessed according to whether they were administered neoadjuvant androgen deprivation therapy or not. (ADT; n = 115, 31.4%).

RESULTS: For the entire cohort, the 36- and 60-month bDFS rates were 65.3% and 51.9%, respectively. Patients who received neoadjuvant ADT had nonsignificantly higher 36- and 60-month bDFS rates (68.0% and 55.4%, respectively) than patients who did not receive neoadjuvant ADT (55.3% and 36.9%, respectively). The reported posttreatment urinary incontinence rate was 2.6%; urinary retention rate, 6.0%; sexual activity rate, 30.4%; and rectourethral fistulization rate, 1.1%.

CONCLUSIONS: Cryoablation for patients with cT3 prostate cancer leads to less favorable bDFS than is reported in the literature following surgery or radiotherapy for the same group of men. Observed, posttreatment rectourethral fistulization rates for patients with cT3 disease are higher than in those with organ-confined prostate cancer treated with cryoablation; however, urinary dysfunction and sexual activity rates are similar for men with cT3 to those reported from this same registry in men with cT2 disease. The addition of neoadjuvant ADT (though not studied prospectively here) should be strongly considered if a patient with cT3 prostate cancer is to be treated with cryoablation.