Gary Mark Onik MD, Presenter: Nothing to Disclose

Following the lead of lumpectomy for breast cancer, focal therapy for prostate cancer was introduced in order to limit morbidity while providing good cancer control. Focal therapy is now an established trend in prostate cancer management, but long term data has not been available. This report presents results on 70 patients treated with focal cryoablation, followed for an average of 10 years.

Between May 7, 1996 and December 28, 2005 70 patients were treated with focal cryoablation. All patients were staged using an additional prostate biopsy. Transperineal 3D Prostate Mapping Biopsy (3D-PMB) was used in 63 patients. All patients were then treated with percutaneous focal cryoablation of all known tumor(s). All known cancers regardless of tumor size or Gleason score were treated. Biochemical disease free status was determined by the Phoenix criteria. Potency was determined by ability to have vaginal penetration and satisfaction with sexual functioning. Continence was determined by pad free status.

Disease specific survival was 64/64(100%). Overall biochemical disease free survival (BDFS) was 62/70 (89%). BDFS results stratified according to the D’Amico criteria were: 8/9 (89%) high risk; 28/32 (88%) medium risk; 26/29 (90%) low risk. There was no statistically significant difference between the risk levels. 19/20 (95%) bilaterally but focally treated patients were BDF. In total 10/70 (14%) patients had a local recurrence that needed re-treatment (none in the treated area), and 9/10 (90%) remain BDF. Continence after the first treatment was 100% (no pads). Potency including re-treatments was 74%. No other complications occurred. There was no instance of significant bleeding and no instance of rectal damage.

Within the limitations of our study, the long term cancer control results of focal therapy using cryoablation appears competitive with radical whole gland treatments in low risk patients and superior in medium and high risk patients in achieving cancer free status . It achieves this with extremely low morbidity compared to whole gland treatments. If these results are confirmed, focal therapy as we have outlined could significantly lower the morbidity and mortality associated with prostate cancer.

Focal therapy has the potential to completely change the paradigm of prostate cancer management.

Onik, G, Long Term Results Of Optimized Focal Therapy Of Prostate Cancer: Average 10-Year Follow-up in 70 Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008689.html