Hemi-gland cryoablation supplies a excessive price of efficient prostate most cancers management
A less invasive treatment technique called hemi-gland cryoablation (HGCryo), which destroys the areas of the prostate where cancers reside by freezing them, offers a high rate, according to a new study published in the Journal of Urology Effective Prostate Cancer Control ®, Official Journal of the American Urological Association (AUA). The magazine is published by Wolters Kluwer in the Lippincott portfolio.
“Cancer-free, as documented by biopsy, was found in 82 percent of men who had undergone HGCryo during their 18-month follow-up,” said Dr. Ryan Chuang and colleagues at the University of California at Los Angeles.
This study also highlights the importance of using a modern magnetic resonance imaging (MRI)-assisted prostate biopsy to monitor the effectiveness of HGCryo.
Cryoablation of the hemi-glands clears clinically significant cancer in most patients
The HGCryo procedure uses an advanced ultrasound / MRI fusion system to precisely place needles in and around the area of the prostate where the cancer is located. Argon gas is then injected to create extremely cold temperatures that destroy the cancer and the surrounding area.
According to the study, 61 men with clinically significant prostate cancer (grade 2 or higher) that involved one side of the prostate were subjected to HGCryo. The cryotherapy was performed under general anesthesia; The patients were discharged on the same day as the procedure. The results were assessed through follow-up imaging examinations and MRI-guided biopsies.
Biopsies were performed in all patients after 6 months; 27 patients underwent an additional biopsy after an 18-month follow-up examination. At both time points, biopsies in 82 percent of patients showed no evidence of clinically significant prostate cancer. Repeated HGCryo treatments or other treatments were effective in men who found areas of prostate cancer at follow-up.
The study evaluated three different biopsy approaches to monitoring HGCryotherapy outcomes: tracking of previous cancer positive sites, biopsy targeting of MRI-visible lesions, and systematic biopsy of the whole prostate using a template. “While tracking the biopsy was the most sensitive, all three methods were required for maximum cancer detection,” write Dr. Chuang and co-authors.
HGCryo provided remarkable cancer control in even six patients with advanced prostate cancer (Grade 3 or 4). None of the patients died from their cancer and none developed metastatic prostate cancer.
Postoperative complications from HGCryo were “generally mild and short-lived”. There were no serious complications, including urinary incontinence – a common complication after prostate cancer surgery. One patient developed erectile dysfunction that was successfully treated with medication.
Cryotherapy is an FDA-approved treatment for prostate cancer and is growing in popularity as a less invasive alternative to surgery. However, there is limited evidence of its long-term effectiveness in fighting prostate cancer. Most prostate cryoablation studies were conducted prior to the availability of an advanced multiparametric MRI scan of the prostate that can provide “a targeted route to precise biopsy and focal treatment” in most men with prostate cancer.
As with other types of partial glandular ablation (PGA) used to treat prostate cancer, the results underscore the importance of follow-up biopsy as a “key success criterion” in evaluating HGCryo results.
As the use of MRI-guided biopsy increases and the resulting improved accuracy in characterization of prostate tissue, the number of candidates for PGA is expected to increase. “
Ryan Chuang, MD, and colleagues, University of California, Los Angeles
R. Chuang et al. (2020) Hemigland Cryoablation of Clinically Significant Prostate Cancer: Interim observation using magnetic resonance imaging-guided biopsy. Journal of Urology. doi.org/10.1097/JU.0000000000001133.