Clinical value of normal saline injection for expansion of the anterior perirectal space during prostate cryoablation

Wang, Ning; Zhao, Diwei; Chen, Dong; Wu, Zhiming; Wang, Yanjun; Yang, Zhenyu; Zhao, Jing; Zhou, Fangjian; Li, Yong-hong

doi:10.1016/j.ejso.2022.06.032

Cited by 1 publication

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“…The future perspective of MRI-guided SFC will need to be shaped by achieving a consensus on appropriate patient selection, the optimal sequence of alternative therapies, such as ADT of radioimmunotherapy, and a proper follow-up protocol to enable adequate long-term management of localized PCa recurrence. Future research concerning rectal wall displacement with saline [ 27 , 28 ], absorbable hydrogel rectal spacers (SpaceOAR) [ 29 ], and transperineal injection of autologous blood [ 30 ] could also prove whether these techniques are beneficial for increasing the safety margins of the iceball to the rectal wall, and thereby reducing the risk of developing rectovesical fistula.…”

Section: Discussionmentioning

confidence: 99%

MRI-Guided Salvage Focal Cryoablation: A 10-Year Single-Center Experience in 114 Patients with Localized Recurrent Prostate Cancer

Wimper

Overduin

Sedelaar

et al. 2023

Cancers

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Patients with localized recurrent prostate cancer (PCa) are eligible for androgen-deprivation therapy, salvage radical prostatectomy (RP) or radiation therapy. These treatments are associated with serious side-effects, illustrating the need for alternative local treatment options with lower morbidity rates. All patients who underwent magnetic resonance imaging (MRI)-guided salvage focal cryoablation (SFC) with localized recurrent PCa between 2011–2021 (n = 114) were included. Two subgroups were formed: patients without (n = 99) and with prior RP (n = 15). We assessed the recurrence- (RFS) and treatment-free survival (TFS), measured from date of treatment to date of recurrence or initiation of additional salvage treatment, using Kaplan–Meier plots. Complications were reported using the Clavien–Dindo (CD) scale. Overall 1-year and 5-year RFS were 76.0% and 25.1%, and overall 1-year and 5-year TFS were 91.5% and 58.2%, respectively. Patients without prior RP showed a significantly higher 1-year (78.5% vs. 52.5%) and 5-year RFS (28.1% vs. 0.0%; p = 0.03), and a trend towards a higher 1-year (92.6% vs. 79.0%) and 5-year TFS (60.2% vs. 23.0%; p = 0.10) compared to those with prior RP. A total of 46 complications occurred in 37 patients, and the overall complication rate was 32.4% (37/114 patients). The majority (41/46; 89.1%) of complications were minor (CD 1–2). Overall (31.3 vs. 40.0%) and major (3.0 vs. 13.3%) complication rates were lower in patients without compared to those with prior RP, respectively. MRI-guided SFC is an effective and safe therapy for patients with recurrent PCa, and has proved to delay and potentially prevent the initiation of salvage treatments. Patients with locally recurrent PCa after prior RP had an increased risk of recurrence, a shortened time to additional treatment, and more complications compared to those without prior RP, which should be considered when selecting patients for SFC.

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