MRI/Transrectal ultrasound guided salvage focal cryoablation for radiorecurrent prostate cancer

Purpose: To report oncologic and functional outcomes of magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) guided salvage hemi-gland cryoablation for radiorecurrent prostate cancer (PCa). Materials and Methods: From a prospectively maintained partial gland ablation database, consecutive patients who underwent MRI/TRUS guided hemi-gland cryoablation (MRI/TRUS CRYO) for radiorecurrent PCa were identified. Multiparametric MRI was acquired before baseline prostate biopsy (PBx) which confirmed clinically significant cancer (CSPCa, Gleason grade group [GG] ≥2) recurrence following radiation therapy (RT). Under MRI/TRUS fusion image guidance, partial gland cryoablation was performed on the lobe harboring CSPCa. The primary endpoint was defined as treatment failure (TF, any radical [whole-gland] treatment, systemic therapy, PCa metastasis, or PCa-specific mortality). Results: A consecutive 10 patients were identified from the database. Median age, PSA, PSA density were 71 years old, 4.51 ng/mL, and 0.16 ng/mL, respectively. GG at the time of recurrence following RT were, 3 (30%) cases for GG 2, 3 (30%) cases for GG 3, 2 (20%) cases for GG 4, and 2 (20%) cases for GG 5. The median length from RT to salvage MRI/TRUS CRYO was 98 months. Median follow-up length, PSA reduction and nadir were 17 months, 86% and 0.8 ng/mL, respectively. Two-year TF free survivals were 100% for treatment failure and 88% for CSPCa recurrence. Urinary continence was maintained in all patients. No patient experienced complications within 90 days postoperatively. Conclusion: MRI/TRUS CRYO for radiorecurrent PCa may be feasible, safe, and expected to achieve adequate cancer control. Validation in larger prospective studies is warranted.