Presentation Authors: Romain Boissier*, Marseille, France, Federica Regis, Barcelona, Spain, Kevin Loverde, Marseille, France, Angelo Territo, Barcelona, Spain, Harry Toledano, Marseille, France, Andrea Gallioli, Barcelona, Spain, Cyrille Bastide, Cyrille Bastide, Dominique Rossi, Marseille, France, Alberto Breda, Joan Palou, Barcelona, Spain
Introduction: Cryoablation (CA) and High-Intensity Focused Ultrasound (HIFU) are alternative treatments to surgery or radiotherapy in localized prostate cancer (PCa). Both techniques have been investigated but had never been directly compared. The aim of the study was to assess and compare oncological outcomes of CA and HIFU as first line treatment in significant localized PCa.
Methods: We conducted a retrospective bicentric comparative study. 139 patients with significant localized PCa underwent CA and HIFU, 40 and 99 respectively from 2005 to 2016. All patient had whole gland treatment. Previous treatment for PCa was an exclusion criteria. Allocation to CA and HIFU was dependant of the institution where the patients were treated. Primary outcome was the biochemical recurrence rate defined by the Phoenix criteria (PSA nadir + 2 ng/mL). Secondary outcomes were: need to secondary treatment, overall survival and comparison of CA and HIFU on oncological outcomes.
Results: Mean age at the diagnosis was 74YO[73-75]95%IC. The risk group was definined according to the Dâ€™amico score. 33% of the patients were low risk (LR), 61% intermediate risk (IR) and 6% high risk (HR). Mean follow-up was 75 months [68-81]95% CI. 71% of the patients reached a PSA nadir < 0.5ng/mL. The 7-yr Biochemical recurrence-free survival (BFRS) rates were 72%, 48%, 35% for LR, IR and HR patients (p=0.02). 22% of patients underwent a second line treatment, after a mean delay of 43 months [31-55] :12(9%) re-Cryo/HIFU, 3(2%)EBRTÂ±ADT, 19(14%)ADT (4/19(3%) for M+ disease). Multivariate analysis identified PSA nadir>0.5 as the strongest independant prognostic factors for biochemical recurrence HZ=3.44[3.86-31.26], p < 0.001.In the comparison of CA vs HIFU, mean age and initial PSA were similar in the two groups (p=0.41) and PSA < 4, 4-10,>10 of respectively 7%, 75% and 18% vs 11%, 56% and 33% (p=0.10) in cryotherapy and HIFU. Initial staging was in favor of HIFU for Dâ€™Amico risk and Gleason stratification:- Gleason < 7 33vs59% and Gleason7 65 vs 38%, (p=0.02) respectively in CA and HIFU- low risk 20vs38% and intermediate risk 78vs55%, (p=0.04) respectively in CA and HIFUWe reported similar oncological outcome in CA vs HIFU: PSA nadir < 0.5 75 vs 69% (p=0.54), 7-yr BFS rates 60 vs 56% (p=0.93), time to recurrence 30vs47 months (p=0.22), and need for a secondary treatment 23vs21% (p=0.86).
Conclusions: Cryotherapy and HIFU provided similar rate of PSA nadir < 0.5,g/mL. Although results were satisfactory in low risk Dâ€™Amico, biochemical recurrence rate for intermediate and high-risk patients were significant