Cryoablation for nonmetastatic castration resistant prostate cancer: feasibility, safety, quality of life and oncological outcomes

Abstract

Abstract Background: Cryoablation is an effective local therapy for prostate cancer for its local tumor killing and activation of systemic immune response. We sought to investigate the feasibility, safety, quality of life (QOL) and oncological outcomes of cryoablation for nonmetastatic castration resistant prostate cancer (CRPC). Methods: The clinical data of 16 patients at our center treated with cryoablation for nonmetastatic CRPC between Jun 2014 and Aug 2018 were analyzed retrospectively. The progression-free survival (PFS) distribution was estimated by Kaplan-Meier analyses and compared by a log-rank test. Results: Median follow-up duration was 32.0months (interquartile range, IQR, 19.6-57.4). There was a Clavien II complication in 1 patient after cryoablation. 5 patients had a clinically significant increase and 2 patients had a clinically significant decrease in Expanded Prostate Cancer Index Composite urinary function QOL score at 3 months postoperation. 14 patients had a decline in prostate-specific antigen(PSA) within 3 months postoperation. PSA progression was occurred in all the patients, and the median PSA PFS time was 3.1months (IQR, 1.9-22.9). The patients with obvious lesion in the prostate of preoperative MRI or PSA < 5.33 ng/ml prior to cryoablation had a better survival (P < 0.05). The immune activation was occurred in 13 patients at 1 day postoperation. Conclusions: Cryoablation has advantages of safety, elevated urinary function QOL, promising oncological outcome and is an appropriate option for patients with nonmetastatic CRPC, especially for those with obvious lesion in the prostate of preoperative MRI or PSA < 5.33 ng/ml prior to cryoablation.