Comparative Effectiveness of Partial Gland Cryoablation Versus Robotic Radical Prostatectomy for Cancer Control

Alec Zhu; Mary O Strasser; Timothy D McClure; Sofia Gereta; Emily Cheng; Kshitij Pandit; Jim C Hu

doi:10.1016/j.euf.2024.04.008

Comparative Effectiveness of Partial Gland Cryoablation Versus Robotic Radical Prostatectomy for Cancer Control

Eur Urol Focus. 2024 Apr 26:S2405-4569(24)00060-9. doi: 10.1016/j.euf.2024.04.008. Online ahead of print.

Authors

Alec Zhu¹, Mary O Strasser¹, Timothy D McClure¹, Sofia Gereta², Emily Cheng¹, Kshitij Pandit¹, Jim C Hu³

Affiliations

¹ Department of Urology, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA.
² Dell Medical School, University of Texas at Austin, Austin, TX, USA.
³ Department of Urology, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA. Electronic address: jch9011@med.cornell.edu.

PMID: 38677913
DOI: 10.1016/j.euf.2024.04.008

Abstract

Background and objective: There is an absence of high-level evidence comparing oncologic endpoints for partial gland ablation, and most series use prostate-specific antigen (PSA) rather than biopsy endpoints. Our aim was to compare oncologic outcomes between partial gland cryoablation (PGC) and radical prostatectomy (RP) for prostate cancer.

Methods: This was a retrospective, single-center analysis of subjects treated with PGC (n = 98) or RP (n = 536) between January 2017 and December 2022 as primary treatment for intermediate-risk (Gleason grade group [GG] 2-3) prostate cancer. Oncologic endpoints included surveillance biopsies per protocol after PGC in comparison to serial PSA testing after RP. The primary outcome was treatment failure, defined as a need for any salvage treatment or development of metastatic disease. Treatment failure and survival analyses were conducted using Cox proportional-hazard regression and Kaplan Meier survival curves.

Key findings and limitations: After applying the inclusion/exclusion criteria, the PGC (n = 75) and RP (n = 298) groups were compared. PGC patients were significantly older (71 vs 64 yr; p < 0.001), but there were no differences in PSA, biopsy GG, or treatment year between the groups. The PGC group had higher rates of treatment failures at 24 mo (33% vs 11%; p < 0.001) and 48 mo (43% vs 14%; p < 0.001). One PGC patient (2.1%) and one RP patient (0.7%) developed metastases by 48-mo follow-up (p = 0.4). On adjusted analysis, PGC was associated with a higher risk of treatment failure (hazard ratio 4.6, 95% confidence interval 2.7-7.9; p < 0.001). Limitations include observational biases associated with the retrospective study design.

Conclusions: This is the first comparative effectiveness study of cancer control outcomes for PGC versus RP. The results demonstrate an almost fivefold higher risk of treatment failure with PGC during short-term follow-up.

Patient summary: We compared cancer control outcomes for patients with intermediate-risk prostate cancer treated with partial gland cryoablation versus radical prostatectomy. We found that partial gland cryoablation had an almost fivefold higher risk of treatment failure. Men with prostate cancer should be counseled regarding this difference in treatment failure.

Keywords: Cryosurgery; Prostatectomy; Prostatic neoplasms; Treatment failure.