MP78-09 FOCAL CRYOABLATION IS ASSOCIATED WITH IMPROVED PATHOLOGICAL PROGRESSION-FREE COMPARED TO ACTIVE SURVEILLANCE IN GLEASON 6 PROSTATE CANCER

Abstract

INTRODUCTION AND OBJECTIVES: Recent level 1 data shows that focal therapy with vascular‐targeted photodynamic treatment in Grade Group (GG) 1 prostate cancer (PCa) reduces pathological progression (PP) and radical treatment compared to active surveillance (AS) at 4 years follow‐up. We aimed to compare PP‐free and treatment‐free survival for focal cryoablation (FC) vs AS in GG 1 (Gleason 6) PCa patients with long‐term follow up. METHODS: We identified 222 consecutive patients undergoing FC (n = 33) or AS (n = 189) for GG 1 PCa between 2002 and 2010 from our institutional review board‐approved database (HS‐13‐00663). All patients had at least 1 follow‐up prostate biopsy (PBx) post‐FC or after entering AS. All patients underwent sextant systematic transrectal ultrasound‐guided PBx, performed by the same operator, using the same protocol during the same period of time. Follow‐up protocols were similar for both groups and included periodic PSA, clinical exam and PBx. These cohorts started in 2002 when MRI was not available. The primary endpoint was PP‐free survival and PP was defined as progression to GG > 2 PCa on follow‐up PBx. The secondary endpoint was treatment‐free survival defined as freedom from any treatment after FC or starting AS. Kaplan‐Meier analysis was used to evaluate PP‐free and treatment‐free survival. RESULTS: Baseline age, PSA, prostate volume, number of biopsy cores taken, number of cancer cores, cancer core length, cancer core percentage, IPSS and SHIM scores were comparable between groups (p>0.05). FC patients had significantly higher PP‐free survival (p<0.01) with a trend towards improved treatment‐free survival (p=0.09) in comparison men undergoing AS. The 5‐year and 10‐year PP‐free survival was 81% and 81% in the FC group compared to 64% and 29% in the AS group (p<0.01) [Figure 1]. The 5‐year and 10‐year treatment‐free survival was 72% and 72% for FC compared to 68% and 32% for AS (p=0.09), respectively. CONCLUSIONS: Focal cryablation is associated with reduced pathological progression from Gleason 6 to Gleason 7 or higher prostate cancer when compared to active surveillance in patients with long‐term follow‐up.