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Prospective trial of regional (hockey-stick) prostate cryoablation: oncologic and quality of life outcomes

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Abstract

Purpose

To report long-term follow-up of the efficacy of subtotal prostate ablation using a “hockey-stick” template, including oncologic control and quality of life (QoL) impact.

Methods

We performed a prospective controlled trial to evaluate the efficacy of subtotal prostate ablation in selected men with baseline and confirmatory biopsy showing grade group (GG) 1–2 prostate cancer. “Hockey-stick” cryoablation that included the ipsilateral hemi-gland and contralateral anterior prostate was performed. Prostate biopsies and QOL queries were performed at 6, 18 and 36 months following regional ablation, and follow-up was updated to include subsequent clinic visits.

Results

Between August 2009 and January 2012, 72 men were screened for eligibility and 47 opted to undergo confirmatory biopsy. Of these, 23 were deemed eligible and treated with regional cryoablation. Median age was 64 years. Median follow-up was 74 months. A single patient had < 1 mm of in-field viable tumor with therapy effect on 36-month biopsy. At time of last follow-up, a total of 12/23 (52%) patients did not have evidence of disease, all patients had preserved urinary control with no patients requiring pads for urinary incontinence. Sexual decline was significant at 3 and 6 months (P < 0.01 for both), though improvement was seen at subsequent time points.

Conclusion

Subtotal (hockey-stick template) cryoablation of the prostate provides oncologic control to targeted tissue in a generally low-risk group with minimal impact on sexual and urinary function. Further studies are needed to evaluate this ablation template in the MRI-targeted era and higher risk populations.

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Acknowledgements

This work was funded by the National Cancer Institute (Grant number P50 CA140388).

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Authors and Affiliations

  1. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Av. Unit 1373, Houston, TX, 77030, USA

    Justin R. Gregg, Leonardo D. Borregales, Marisa Lozano, John W. Davis, Louis L. Pisters & John F. Ward

  2. Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Haesun Choi & Aradhana M. Venkatesan

  3. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Stephen E. McRae

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Graciela M. Nogueras-Gonzalez

Authors
  1. Justin R. Gregg
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  2. Leonardo D. Borregales
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  4. Marisa Lozano
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  9. Louis L. Pisters
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  10. John F. Ward
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Contributions

JRG: data collection, data analysis, manuscript writing; LDB: data collection, data analysis, manuscript writing/editing; HC: protocol development, management, manuscript editing; ML: protocol development, management, editing; SEM: protocol development, management, editing; AMV: protocol development, management, editing; JWD: protocol development, management, editing; GMN-G: protocol development, data analysis, editing; LLP: protocol development, management, editing; JFW: protocol development, data collection, management, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Justin R. Gregg.

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Conflict of interest

JW Davis is a consultant/speaker for Intuitive Surgical. All other authors have no conflicts of interest to disclose. This study was approved by the institutional IRB and involved human participants. All involved patients signed an informed consent document.

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Gregg, J.R., Borregales, L.D., Choi, H. et al. Prospective trial of regional (hockey-stick) prostate cryoablation: oncologic and quality of life outcomes. World J Urol 39, 3259–3264 (2021). https://doi.org/10.1007/s00345-020-03575-4

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  • DOI: https://doi.org/10.1007/s00345-020-03575-4

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