Clinical and biochemical outcomes of high-risk prostate cancer patients treated with third generation prostate cryosurgery

Objectives: To report on outcomes after modern-day primary prostate cryosurgery (CS) in D'Amico high-risk (PSA >20 ng/ml, Gleason score ≥ 8, or tumor stage T2c or T3) localised prostate cancer (PCa) patients treated at a large academic center. Materials and Methods: 730 consecutive cases of total gland prostate CS were reviewed, and 80 men with high-risk disease identified. Clinical data was analyzed, with primary and secondary endpoints being overall survival, cancerspecific survival, biochemical recurrence (BCR), and clinical progression. Results: Median age was 75.8 (55.4-88.1) years, median presenting PSA 20.0 (2.6-236.5) ng/ml, and median Gleason score 8 (6-10). Median follow-up was 49.6 (8.9-159.3) months. There were three PCa related deaths (4%); 34 (43%) and 39 (49%) men had BCR as defined by the Phoenix- and Stuttgart-criteria, respectively; 24 of the 39 (64%) men were rebiopsied. 13 of 80 (16%) had biopsy proven recurrent PCa. Nine (11%) subsequently underwent salvage CS. Six of the 39 (15%) men with BCR had metastatic disease on bone scan; 19 of 34 (49%) men with BCR received anti-androgen therapy, 18 (95%) of whom had also received neoadjuvant hormonal therapy. Conclusions: Prostate CS is a controversial treatment for high-risk patients, and our early experience revealed low cancer-specific mortality and morbidity, with encouraging biochemical and local control rates for these high-risk patients. In our series the incidence of metastases was less than that reported by Bolla et al. post-EBRT and hormones, and we therefore believe that prostate CS be strongly considered for these high-risk patients, and mandate that further study of CS for high-risk disease is warranted.