Long-Term Results of Optimized Focal Therapy for Prostate Cancer: Average 10-Year Follow-Up in 70 Patients

Background: Following the lead of lumpectomy for breast cancer, focal therapy for prostate cancer was introduced in order to limit morbidity while providing good cancer control. Focal therapy is now an established trend in prostate cancer management, but long-term data have not been available. This report presents results on 70 patients treated with focal cryoablation, followed for an average of 10 years. Methods: Between May 7, 1996, and December 28, 2005, seventy patients were treated with focal cryoablation. All patients were pre-staged using an additional prostate biopsyeither transrectal ultrasound (TRUS) biopsy or transperineal three-dimensional prostate mapping biopsy (3D-PMB). All patients were treated with focal cryoablation of the known tumor(s). Biochemical disease-free status was determined by the Phoenix criteria. Results: Disease-specific survival was 66/66 (100%). Overall biochemical disease-free survival (BDFS) was 62/70 (89%). BDFS results stratified according to the D'Amico criteria were: 8/9 (89%) high risk; 28/32 (88%) medium risk; and 26/29 (90%) low risk. There was no statistically significant difference between the risk levels. Of those patients staged by TRUS biopsy, 8 of 24 patients had a documented local recurrence (33%). Of those staged by (3D-PMB), 2 of 46 (4%) patients had a local recurrence. Nine out of ten retreated local recurrences (90%) remain BDF. Continence after the first treatment was 100% (no pads). Potency after the first treatment was 94%, including retreatments it was 74%. Conclusions: The long-term cancer control results of focal cryoablation appear superior in medium- and high-risk patients to radical whole gland treatments. Focal therapy is associated with extremely low morbidity. If confirmed and applied widely, focal cryoablation could result in a substantial decrease in prostate cancer related mortality while offering a better post treatment quality of life.