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

Abstract

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.

Treatment Planning Strategies for Interstitial Ultrasound Ablation of Prostate Cancer

“…Thermal ablation [8] , [9] , [10] , [11] as a means of focal therapy has acquired substantial attention in recent years as clinical evidence continues to demonstrate its efficacy for prostate disease. Focal prostate thermal ablation [12] is primarily indicated for patients with localized low-grade prostate cancer, and can be applied with percutaneous or interstitial approaches such using radiofrequency (RF) [13] , laser [14] , microwave [15] energy sources or cryoablation [16] , as well as endocavity transrectal high-intensity focused ultrasound [17] and MR guided transurethral ultrasound TULSA [18] . The transrectal and transurethral ultrasound ablation systems offer superior spatial control of the energy deposition compared to the interstitial technology, albeit with a more time consuming and complex integration.…”