Crioablación total o hemiglandular para el cáncer de próstata primario localizado: resultados oncológicos y funcionales a corto y medio plazo / Whole and hemi-gland cryoablation for primary localized prostate cancer: Short and medium-term oncological and functional outcomes

INTRODUCCIÓN: Comparar los resultados oncológicos, funcionales y postoperatorios de la crioablación hemiglandular (CH) vs. crioablación de toda la glándula (CT) como terapia primaria del cáncer de próstata localizado. MATERIAL Y MÉTODO: Se incluyeron 66 pacientes consecutivos tratados entre 2010 y 2018 con crioablación total (CT = 40) o crioablación hemiglandular (CH = 26) en un centro de referencia terciario. Todos los pacientes tenían cáncer de próstata de riesgo bajo-intermedio según criterios D'Amico. Se propuso crioablación hemiglandular en caso de cáncer de próstata unilateral comprobado por biopsia y RM. La variable principal de evaluación fue el fracaso de la crioterapia, para el que se consideraron y compararon tres definiciones: 1) fallo bioquímico (> PSA nadir + ≥ 2 ng/mL), 2) rebiopsia positiva de próstata Gleason ≥ 7, y 3) inicio de un tratamiento adicional para el cáncer de próstata. RESULTADOS: La edad media de los pacientes durante el tratamiento fue 74 [42-81] vs.76 [71-80] años en el grupo de CT vs. CH, respectivamente (p = 0,08). Los grupos de riesgo bajo e intermedio (D'Amico) fueron 15% y 85% frente a 23% y 77% (p = 0,75), respectivamente. El tiempo medio de seguimiento fue de 41 [1,5-99,0] vs.27 [0,9-93] meses (p = 0,03). La supervivencia libre de fracaso de la crioterapia a cuatro años en CT vs. CH fue de 69% vs.53% con la definición 1 (p = 0,24), 82% vs.80% con la definición 2 (p = 0,95), y 83% vs.77% con la definición 3 (p = 0,73). La continencia urinaria postoperatoria y al año fue de 60% y 83% en CT frente a 72% y 83% en CH (p = 0,26). La impotencia de novo tras la crioterapia fue del 75% frente al 46% (p = 0,33) en CT y CH, respectivamente. CONCLUSIONES: En nuestra cohorte de pacientes altamente seleccionados con CP unilateral de riesgo bajo-intermedio, la crioterapia hemiglandular puede proporcionar resultados oncológicos similares y menos complicaciones tempranas en comparación con la crioablación de toda la glándula

INTRODUCTION: To compare oncological, functional and post-operative outcomes of hemi (HC) vs. whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. MATERIAL AND METHOD: Sixty-six consecutive patients undertaking whole-gland cryoablation (WGC = 40) or hemi-cryoablation (HC = 26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D'Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir+ ≥ 2 ng/mL), 2) positive prostate re-biopsy with Gleason score ≥ 7, 3) initiation of further prostate cancer treatment. RESULTS: Median patients age at treatment was 74 [42-81] vs.76 [71-80] years in WGC vs. HC group, respectively (p=.08). Low and intermediate D'Amico risk group were 15% and 85% vs.23% and 77% (p=.75), respectively. Median follow- up time was 41 [1.5-99.0] vs.27 [0.9-93] months (p=.03). Four-years cryotherapy failure free survival in WGC vs. HC were 69% vs.53% with definition 1 (p=.24), 82% vs.80% with definition 2 (p=.95), 83% vs.77% with definition 3 (p=.73). Early and 1-year urinary continence were 60% and 83% in WGC vs.72% and 83% in HC (p=.26). De novo impotency after cryotherapy was 75% vs.46% (p=.33) in WGC vs. HC. CONCLUSIONS: In our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation

Whole and hemi-gland cryoablation for primary localized prostate cancer: Short and medium-term oncological and functional outcomes. / Crioablación total o hemiglandular para el cáncer de próstata primario localizado: resultados oncológicos y funcionales a corto y medio plazo.

INTRODUCTION: To compare oncological, functional and post-operative outcomes of hemi (HC) vs. whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. MATERIAL AND METHOD: Sixty-six consecutive patients undertaking whole-gland cryoablation (WGC=40) or hemi-cryoablation (HC=26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D'Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir+≥ 2 ng/mL), 2) positive prostate re-biopsy with Gleason score ≥ 7, 3) initiation of further prostate cancer treatment. RESULTS: Median patients age at treatment was 74 [42-81] vs. 76 [71-80] years in WGC vs. HC group, respectively (p=.08). Low and intermediate D'Amico risk group were 15% and 85% vs. 23% and 77% (p=.75), respectively. Median follow- up time was 41 [1.5-99.0] vs. 27 [0.9-93] months (p=.03). Four-years cryotherapy failure free survival in WGC vs. HC were 69% vs. 53% with definition 1 (p=.24), 82% vs. 80% with definition 2 (p=.95), 83% vs. 77% with definition 3 (p=.73). Early and 1-year urinary continence were 60% and 83% in WGC vs. 72% and 83% in HC (p=.26). De novo impotency after cryotherapy was 75% vs. 46% (p=.33) in WGC vs. HC. CONCLUSIONS: In our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation.