10 Year Experience of Prostate Total and Partial Cryoablation
Louis Liou, MD, PhD1; Carter Liou, BA2; Amanda Farrell, BA1
1Cambridge Health Alliance, Cambridge, MA; 2Colby College, Waterville, ME
BACKGROUND: Cryoablation of the prostate is a well established treatment modality for prostate cancer. We present the 10 year experience of both total gland and partial gland ablation by a single surgeon.
METHODS: A retrospective review was conducted of 27 patients who underwent partial or total prostate cryoablation between 2008 and 2018. Data on preoperative PSA, Pathology, IPSS, IIEF as well as post operative PSA, complications, and cancer control were collected. Follow up ranged from 1 month to 10 years.
RESULTS: There were a total of 28 ablative procedures on 27 patients. Age ranged from 52 to 82 while the average was 68. There were 6 partial ablations which had an average age of 62. Average Preop PSA was 12. Average prostate size was 46 grams for an average PSA density of 0.26. Nine patients had Gleason 6, Twelve had Gleason 7, and Six had Gleason 8, 9,or 10. Average post operative PSA was 443 in the PACU, 150 on POD1, and the nadir was one month at 1.6. There was one bladder neck contracture, one episode of renal failure requiring short term dialysis, four UTIs, and 13 post op retentions requiring the replacement of a foley. There were four post op biopsy confirmed prostate cancer recurrences. Four had XRT adjuvant therapy while one had a repeat cryoablation. There were three deaths during the 10 year period, one was prostate cancer specific while the other two were from lung cancer and AML. Five of the six partial prostate ablative patients had good sexual function after the procedure and one had a biopsy proven recurrence on the contralateral side.
CONCLUSIONS: Prostate cryoabation is safe and effective as a modality for prostate cancer treatment in a select population of patients. In addition, focal ablation is feasible and safe with preservation of erectile function. Although, the past literature suggests that cryoablation of the prostate can lead to better urinary symptoms, we have found that 46% of our patients had retention within the first month after treatment. This eventually resolved but patients should be counseled about the potential additional need for prostate medications or procedures for obstructive symptoms. More experience is needed in the area of focal ablative therapy for prostate cancer. The introduction of MRI fusion technology gives ablative techniques such as cryoablation a more targeted approach to treatment with less side effects and better quality of life.
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