mpMRI-US Fusion-Guided Targeted Cryotherapy in Patients with Primary Localized Prostate Cancer: A Prospective Analysis of Oncological and Functional Outcomes.
Author: Fernández Pascual, Esaú; Manfredi, Celeste; Martín, Cristina; Martínez-Ballesteros, Claudio; Balmori, Carlos; Lledó-García, Enrique; Quintana, Luis Miguel; Curvo, Raphael; Carballido-Rodríguez, Joaquín; Bianco, Fernando J.; Martínez Salamanca, Juan Ignacio
Abstract: Targeted therapy (TT) for prostate cancer (PCa) aims to ablate the malignant lesion with
an adequate margin of safety in order to obtain similar oncological outcomes, but with less toxicity
than radical treatments. The main aim of this study was to evaluate the recurrence rate (RR) in
patients with primary localized PCa undergoing mpMRI/US fusion targeted cryotherapy (FTC). A
secondary objective was to evaluate prostate-specific antigen (PSA) as a predictor of recurrences.
We designed a prospective single-center single-cohort study. Patients with primary localized PCa,
mono or multifocal lesions, PSA 15 ng/mL, and a Gleason score (GS) 4 + 3 undergoing FTC
were enrolled. RR was chosen as the primary outcome. Recurrence was defined as the presence of
clinically significant prostate cancer in the treated areas. PSA values measured at different times were
tested as predictors of recurrence. Continuous variables were assessed with the Bayesian t-test and
categorical assessments with the chix-squared test. Univariate and logistic regression assessment
were used for predictions. A total of 75 cases were included in the study. Ten subjects developed a
recurrence (RR: 15.2%), while fifty-six (84.8%) patients showed a recurrence-free status. A %PSA drop
of 31.5% during the first 12 months after treatment predicted a recurrence with a sensitivity of 53.8%
and a specificity of 79.2%. A PSA drop of 55.3% 12 months after treatment predicted a recurrence
with a sensitivity of 91.7% and a specificity of 51.9%. FTC for primary localized PCa seems to be
associated with a low but not negligible percentage of recurrences. Serum PSA levels may have a role
indicating RR.
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