Primary Partial Gland Cryo-Ablation Shows Success in Intermediate-Risk Prostate Cancer, unravels study

The researchers found that the intermediate-term oncological outcomes following PPGCA were highly encouraging, supported by excellent compliance with a rigorous prospective protocol for detecting recurrent clinically significant prostate cancer (csPCa).

PPGCA, a minimally invasive procedure, targets cancerous cells within the prostate while preserving as much healthy tissue as possible. This approach not only aims to manage cancer but also to reduce the potential side effects often associated with more extensive surgeries. Considering this, Herbert Lepor, Department of Urology, NYU Grossman School of Medicine, New York, NY, and colleagues aimed to evaluate the 5-year oncologic outcomes after PPGCA in patients with intermediate-risk prostate cancer.

For this purpose, the researchers enrolled 476 men undergoing PPGCA in their prospective study on oncologic and functional outcomes. Among these, 313 participants had MRI-concordant intermediate-risk prostate cancer, with no evidence of out-of-field Gleason Grade Group (GGG) ≥2, gross extracapsular extension, or severe apical disease on pre-treatment mpMRI. PSA levels were monitored every six months, and mpMRI assessments were conducted at 6-12, 24, 42, and 60 months.

Following an interim analysis that indicated low rates of clinically significant prostate cancer defined as any GGG≥2 disease, protocol biopsies at 6-12 months and 24 months were discontinued. Freedom-from-failure (FFF) was defined as the absence of prostate cancer-specific mortality, metastatic disease, or whole-gland salvage treatment (WGST).

The following were the key findings of the study:

• Clinically significant prostate cancer was identified in 10.5% of participants.
• Among the 91 subjects with at least 4.5 years of follow-up data, the mean number of surveillance procedures included 8.9 PSA tests, 3.4 MRIs, and 2.0 prostate biopsies, with no participants lost to follow-up.
• At the five-year mark, the rates of freedom from recurrence were as follows:
• • In-field csPCa: 86%
  • Out-of-field csPCa: 85%
  • Overall csPCa: 70%
• The proportion of participants achieving freedom from failure at five years was 89%.
• There were no deaths due to prostate cancer; however, one participant (1%) developed metastasis.
• 16.5% of participants underwent whole-gland salvage treatment, and 16.5% received salvage focal therapy (FT).
• Compliance with the five-year surveillance protocol was high, with only 3.3% of eligible men being non-compliant.

The prospective 5-year study offers strong oncological evidence supporting the use of Primary Partial Gland Cryo-Ablation (PPGCA) for carefully selected men with intermediate-risk prostate cancer.

"Our previously published results indicate that these favorable oncological outcomes are achieved without rectal injury or urinary incontinence," the researchers wrote.

Additionally, lower urinary tract symptoms (LUTS) improved with only a modest effect on sexual function. This reinforces the potential of PPGCA as a viable treatment option for this patient population," they concluded.

Reference:

Lepor, H., Rapoport, E., Tafa, M., Gogaj, R., & Wysock, J. S. (2024). 5-year Oncologic Outcomes Following Primary Partial Gland Cryo-Ablation (PPGCA) Prospective Cohort Study of Men with Intermediate-Risk Prostate Cancer. Urology. https://doi.org/10.1016/j.urology.2024.10.039