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Lee H, Thakker S, Pineault K, Wysock J, Tan WP. Salvage Cryoablation for Recurrent Prostate Cancer Following Radiation-A Comprehensive Review. Cancers (Basel) 2024; 16:2717. [PMID: 39123445 PMCID: PMC11312114 DOI: 10.3390/cancers16152717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
The treatment options for prostate cancer typically entail active surveillance, surgery, radiation, or a combination of the above. Disease recurrence remains a concern, with a wide range of recurrence rates having been reported in the literature. In the setting of recurrence, the salvage treatment options include salvage prostatectomy, salvage high-intensity focused ultrasound (HIFU), stereotactic body radiotherapy (SBRT), salvage brachytherapy, and salvage cryoablation. In this review, we analyze the currently available data related to salvage cryoablation for recurrent prostate cancer following radiation.
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Affiliation(s)
| | | | | | | | - Wei Phin Tan
- Department of Urology, NYU Langone Health, New York, NY 10016, USA
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2
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Qian Z, Filipas DK, Koelker M, Stone BV, Beatrici E, Labban M, Tuncali K, Lipsitz S, Trinh QD, Cole AP. Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer. Clin Genitourin Cancer 2024; 22:102184. [PMID: 39241314 DOI: 10.1016/j.clgc.2024.102184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 07/25/2024] [Accepted: 07/28/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Focal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the 2 cancers to discern health system determinants affecting the adoption of these treatments. METHODS The study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed interhospital variability through ranked caterpillar plots and Spearman correlation coefficient. RESULTS Among 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The interhospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; P < .001). CONCLUSIONS Our analysis revealed a substantial hospital-level discrepancy in the utilization of focal therapy. Despite this, there was a limited correlation between the use of focal therapy for these two types of cancer within the same hospital. Our findings emphasize the presence of multifaceted factors influencing the adoption of focal therapy, both at facility and healthcare system levels.
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Affiliation(s)
- Zhiyu Qian
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Dejan K Filipas
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Koelker
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin V Stone
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Edoardo Beatrici
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Muhieddine Labban
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Kemal Tuncali
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Alexander P Cole
- Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
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Diven M, Ballman K, Marciscano A, Barbieri C, Piscopo J, Wang S, Nagar H, McClure T. Radiation therapy and IRreversible electroporation for intermediate risk prostate cancer (RTIRE). BMC Urol 2024; 24:151. [PMID: 39054460 PMCID: PMC11271032 DOI: 10.1186/s12894-024-01506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Radiation Therapy and IRreversible Electroporation for Intermediate Risk Prostate Cancer (RTIRE) is a phase II clinical trial testing combination of radiation therapy and irreversible electroporation for intermediate risk prostate cancer BACKGROUND: PCa is the most common non-cutaneous cancer in men and the second leading cause of cancer death in men. PCa treatment is associated with long term side effects including urinary, sexual, and bowel dysfunction. Management of PCa is based on risk stratification to prevent its overtreatment and associated treatment-related toxicity. There is increasing interest in novel treatment strategies, such as focal therapy, to minimize treatment associated morbidity. Focal therapy alone has yet to be included in mainstream guidelines, given ongoing concerns with potentially higher risk of recurrence. We hypothesize combining focal therapy with whole gland, reduced dose radiotherapy will provide acceptable oncologic efficacy with minimal treatment associated morbidity. RTIRE is a phase II single institution, investigator-initiated study combining a local ablative technique though local irreversible electroporation (IRE) with MR guided RT (MRgRT) to treat the entire prostate. The goal is to provide excellent oncologic outcomes and minimize treatment related side effects through leveraging benefits of locally ablative therapy with established radiation treatment techniques. METHODS A total of 42 men with intermediate risk PCa per NCCN guidelines and focal grade group (GG) 2 or 3, Gleason Score (GS) 3 + 4 or GS 4 + 3, cancer in an MRI target will be enrolled. Patients with MRI visible foci of GG2/GG3 will undergo focal therapy with IRE of this lesion. Following successful focal therapy, patients will then undergo a course of reduced dose, whole gland MRgRT with either 32.5 Gy in 5 Fractions or 22 Gy in 2 fractions. The primary objective of the study is to determine safety. Secondary outcomes include evaluation of oncologic efficacy (as measured by the proportion of patients free of clinically significant cancer as defined as > Grade Group 1 at 1-year follow-up biopsy), imaging characteristics of patients pre and post RTIRE, impact on quality of life (QoL), and PSA kinetics. DISCUSSION Combining IRE with a reduced dose radiotherapy may offer a new treatment paradigm for PCa by both reducing treatment effects of full dose radiotherapy and minimizing the risk of recurrence observed with focal therapy. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05345444. Date of registration: April 25, 2022. PROTOCOL VERSION 6.0, July 7, 2023.
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Affiliation(s)
- Marshall Diven
- Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Karla Ballman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Ariel Marciscano
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jennifer Piscopo
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Shu Wang
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy McClure
- Department of Urology, Weill Cornell Medicine, New York, NY, USA.
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Vrabel MR, Fesmire CC, Rich MJ, Kobrin RL, Sano MB, Zaharoff DA. A novel in vitro model of clinical cryoablation to investigate the transition zone for focal tumor ablation. Cryobiology 2024; 114:104844. [PMID: 38171448 DOI: 10.1016/j.cryobiol.2023.104844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024]
Abstract
Cryoablation (CA) of solid tumors is highly effective at reducing tumor burden and eliminating small, early stage tumors. However, complete ablation is difficult to achieve and cancer recurrence is a significant barrier to treatment of larger tumors compared to resection. In this study, we explored the relationship between temperature, ice growth, and cell death using a novel in vitro model of clinical CA with the Visual-ICE (Boston Scientific) system, a clinically approved and widely utilized device. We found that increasing the duration of freezing from 1 to 2 min increased ice radius from 3.44 ± 0.13 mm to 5.29 ± 0.16 mm, and decreased the minimum temperature achieved from -22.8 ± 1.3 °C to -45.5 ± 7.9 °C. Furthermore, an additional minute of freezing increased the amount of cell death within a 5 mm radius from 42.5 ± 8.9% to 84.8 ± 1.1%. Freezing at 100% intensity leads to faster temperature drops and a higher level of cell death in the TRAMP-C2 mouse prostate cancer cell line, while lower intensities are useful for slow freezing, but result in less cell death. The width of transition zone between live and dead cells decreased by 0.4 ± 0.2 mm, increasing from one to two cycles of freeze/thaw cycles at 100% intensity. HMGB-1 levels significantly increased with 3 cycles of freeze/thaw compared to the standard 2 cycles. Overall, a longer freezing duration, higher freezing intensity, and more freeze thaw cycles led to higher levels of cancer cell death and smaller transition zones. These results have the potential to inform future preclinical research and to improve therapeutic combinations with CA.
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Affiliation(s)
- Maura R Vrabel
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA.
| | - Christopher C Fesmire
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, Raleigh, NC, USA.
| | - Matthew J Rich
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, Raleigh, NC, USA.
| | - Robert L Kobrin
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, Raleigh, NC, USA.
| | - Michael B Sano
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Department of Molecular and Biomedical Sciences, North Carolina State University, Raleigh, NC, USA.
| | - David A Zaharoff
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, Raleigh, NC, USA; Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
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Faiella E, Santucci D, D’Amone G, Cirimele V, Vertulli D, Bruno A, Beomonte Zobel B, Grasso RF. Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies. Cancers (Basel) 2024; 16:765. [PMID: 38398156 PMCID: PMC10887212 DOI: 10.3390/cancers16040765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. METHODS Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. RESULTS Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. CONCLUSIONS The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa.
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Affiliation(s)
| | | | - Giulia D’Amone
- Department of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy; (E.F.); (D.S.); (V.C.); (D.V.); (A.B.); (B.B.Z.); (R.F.G.)
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Li Y, Li F, Han S, Ning J, Su P, Liu J, Qu L, Huang S, Wang S, Li X, Li X. Performance of 18F-DCFPyL PET/CT in Primary Prostate Cancer Diagnosis, Gleason Grading and D'Amico Classification: A Radiomics-Based Study. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:576-585. [PMID: 38223686 PMCID: PMC10781655 DOI: 10.1007/s43657-023-00108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 01/16/2024]
Abstract
This study aimed to investigate the performance of 18F-DCFPyL positron emission tomography/computerized tomography (PET/CT) models for predicting benign-vs-malignancy, high pathological grade (Gleason score > 7), and clinical D'Amico classification with machine learning. The study included 138 patients with treatment-naïve prostate cancer presenting positive 18F-DCFPyL scans. The primary lesions were delineated on PET images, followed by the extraction of tumor-to-background-based general and higher-order textural features by applying five different binning approaches. Three layer-machine learning approaches were used to identify relevant in vivo features and patient characteristics and their relative weights for predicting high-risk malignant disease. The weighted features were integrated and implemented to establish individual predictive models for malignancy (Mm), high path-risk lesions (by Gleason score) (Mgs), and high clinical risk disease (by amico) (Mamico). The established models were validated in a Monte Carlo cross-validation scheme. In patients with all primary prostate cancer, the highest areas under the curve for our models were calculated. The performance of established models as revealed by the Monte Carlo cross-validation presenting as the area under the receiver operator characteristic curve (AUC): 0.97 for Mm, AUC: 0.73 for Mgs, AUC: 0.82 for Mamico. Our study demonstrated the clinical potential of 18F-DCFPyL PET/CT radiomics in distinguishing malignant from benign prostate tumors, and high-risk tumors, without biopsy sampling. And in vivo 18F-DCFPyL PET/CT can be considered a noninvasive tool for virtual biopsy for personalized treatment management. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-023-00108-y.
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Affiliation(s)
- Yuekai Li
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012 China
| | - Fengcai Li
- Department of Hepatology, Qilu Hospital of Shandong University, Wenhuaxi Road 107#, Jinan, 250012 China
| | - Shaoli Han
- Evomics Medical Technology Co., Ltd, Shanghai, 201203 China
| | - Jing Ning
- Evomics Medical Technology Co., Ltd, Shanghai, 201203 China
| | - Peng Su
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012 China
| | - Jianfeng Liu
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012 China
| | - Lili Qu
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012 China
| | - Shuai Huang
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012 China
| | - Shiwei Wang
- Evomics Medical Technology Co., Ltd, Shanghai, 201203 China
| | - Xin Li
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012 China
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
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Deivasigamani S, Orabi H, El-Shafei A, Adams ES, Kotamarti S, Aminsharifi A, Davis L, Wu Y, J SJ, Polascik TJ. Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis. Prostate 2023; 83:1373-1386. [PMID: 37469120 DOI: 10.1002/pros.24600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT). METHODS An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW. RESULTS A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different. CONCLUSION CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.
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Affiliation(s)
- Sriram Deivasigamani
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Hazem Orabi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed El-Shafei
- Department of Urology, University of Florida Health, Jacksonville, Florida, USA
| | - Eric S Adams
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Srinath Kotamarti
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ali Aminsharifi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Leah Davis
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuan Wu
- Duke Cancer Institute and Department of Statistics, Durham, North Carolina, USA
| | | | - Thomas J Polascik
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
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Tan WP, Kotamarti S, Ayala A, Mahle R, Chen E, Arcot R, Chang A, Michael Z, Seguier D, Polascik TJ. Oncological and Functional Outcomes for Men Undergoing Salvage Whole-gland Cryoablation for Radiation-resistant Prostate Cancer. Eur Urol Oncol 2023; 6:289-294. [PMID: 36890104 DOI: 10.1016/j.euo.2023.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND There is no consensus on the optimal approach for salvage local therapy in radiation-resistant/recurrent prostate cancer (RRPC). OBJECTIVE To investigate oncological and functional outcomes for men treated with salvage whole-gland cryoablation (SWGC) of the prostate for RRPC. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed our prospectively collected cryosurgery database between January 2002 and September 2019 for men who were treated with SWGC of the prostate at a tertiary referral center. INTERVENTION SWGC of the prostate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was biochemical recurrence-free survival (BRFS) according to the Phoenix criterion. Secondary outcomes included metastasis-free survival, cancer-specific survival, and adverse events. RESULTS AND LIMITATIONS A total of 110 men with biopsy-proven RRPC were included in the study. Median follow-up for patients without biochemical recurrence (BCR) after SWGC was 71 mo (interquartile range [IQR] 42.3-116). BRFS was 81% at 2 yr and 71% at 5 yr. A higher prostate-specific antigen (PSA) nadir after SWGC was associated with worse BRFS. The median International Index of Erectile Function-5 score was 5 (IQR 1-15.5) before SWGC and 1 (IQR 1-4) after SWGC. Stress urinary incontinence, strictly defined as the use of any pads after treatment, was 5% at 3 mo and 9% at 12 mo. Clavien-Dindo grade ≥3 adverse events occurred in three patients (2.7%). CONCLUSIONS In patients with localized RPPC, SWGC achieved excellent oncological outcomes with a low rate of urinary incontinence, and represents an alternative to salvage radical prostatectomy. Patients with fewer positive cores and lower PSA tended to have better oncological outcomes following SWGC. PATIENT SUMMARY For men with prostate cancer that persists after radiotherapy, a freezing treatment applied to the whole prostate gland can achieve excellent cancer control. Patients who did not have elevated prostate-specific antigen (PSA) at 6 years after this treatment appeared to be cured.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Urology, New York University Langone Health, New York, NY, USA
| | - Srinath Kotamarti
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Emily Chen
- Duke University School of Medicine, Durham, NC, USA
| | - Rohith Arcot
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Andrew Chang
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Zoe Michael
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Denis Seguier
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Jiang X, Zujin J, Xinyi L, Cui L, Fangjun Y. Suitable T stage for cryosurgery to spare the anus in patients with low rectal cancer. Cryobiology 2023:S0011-2240(23)00036-6. [PMID: 37182732 DOI: 10.1016/j.cryobiol.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
Sphincter preserving therapy is a key research focus for treating low rectal cancer; however, the role of cryotherapy in this process has seldom been reported in the literature. Therefore, we conducted a comprehensive report on the role of cryoablation in sphincter preservation and explored its effect in rectal cancers. An observational study used longitudinal observation and follow-up. Participants were screened from patients whose medical records showed cryotherapy intervention for low rectal cancers from January 2016 to December 2020, with more than 2 years of follow-up. The primary endpoint was progress-free survival, and the secondary outcomes were mainly related to sphincter preservation rate and complications. Thirty-five patients were enrolled in this study, all of whom had their sphincters preserved. Until June 2022, 35 cases achieved long-term progression-free survival (41.77 ± 15.58), with no recurrence observed in 88.57% (31/35) of all patients at follow-up. Cryotherapy showed no significant differences in progress-free survival between sexes (p > 0.05). Cox regression was used to analyze the factors affecting local recurrence, with sex, T stage, size, and cryo-time taken as covariates. The results showed that T stage was a risk factor for local recurrence (p = 0.01, odds ratio: 16.27, 95% confidence interval: 8.20,145.75). Analysis of the T stage according to different subgroups showed that T3 stage was an independent risk factor (p = 0.002). We observed seven cases of complications, which were classified into grades I-II. In patients with low rectal cancers, cryotherapy can safely and effectively preserve the anus and avoid low anterior resection syndrome. Cryoablation has a better curative effect on radical treatment, especially for tumors in the T0-2 N0M0 stage.
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Affiliation(s)
- Xuejun Jiang
- Department of Colorectal and Anal Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, PR China.
| | - Ji Zujin
- Department of Colorectal and Anal Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, PR China
| | - Lei Xinyi
- Department of Colorectal and Anal Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, PR China
| | - Liu Cui
- Department of Colorectal and Anal Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, PR China
| | - Yuan Fangjun
- Department of Colorectal and Anal Surgery, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, PR China.
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Affiliation(s)
- Wei Phin Tan
- Department of Urology, NYU Langone Health, New York, NY, USA.
| | - James S Wysock
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Health, New York, NY, USA
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11
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Masone MC. WGC in patients with localized prostate cancer. Nat Rev Urol 2022; 19:694. [PMID: 36316465 DOI: 10.1038/s41585-022-00673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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