Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

Objectives. To define the potential role of cryosurgical ablation of the pr ostate (CSAP) as a treatment option for patients with localized prostate ca rcinoma (PCA), we performed a retrospective outcomes analysis of a large da tabase of patients undergoing CSAP constructed from five institutions and c ompared this with matching outcomes from contemporary reports of patient ou tcomes after radiotherapy. Methods. A total of 975 patients who underwent CSAP as primary therapy from January 1993 to January 1998 with sufficient outcomes data available were identified. Patients were stratified into three groups on the basis of thei r clinical features. Biochemical-free survival (BFS), post-CSAP biopsy resu lts, and post-CSAP morbidities were calculated and recorded. Results. The median follow-up for all patients was 24 months. The percentag es of patients in the low, medium, and high-risk groups were 25%, 34%, and 41%, respectively. For prostate-specific antigen thresholds of less than 0. 5 and less than 1.0 ng/mL, the 5-year actuarial BFS ranged from 36% to 61% and 45% to 76%, respectively, depending on the risk category. Overall, the positive biopsy rate was 18%, Morbidities included impotence in 93%, incont inence in 7.5%, rectourethral fistula in 0.5%, and transurethral resection of the prostate in 13% of patients (10% approved warming catheters versus 4 0% nonapproved). Conclusions. For each risk group, the 5-year BFS and positive biopsy rate a fter CSAP was comparable to matching outcomes reported after radiotherapy. Morbidities also seemed comparable, with impotence rates higher and rectal injury rates lower after CSAP than after radiotherapy. These data indicate that CSAP can be performed with low morbidity and can produce cancer-relate d results comparable to those reported for patients undergoing radiotherapy . UROLOGY 57: 518-523, 2001. (C) 2001, Elsevier Science Inc.