The efficacy and safety of the long-term experience with targeted
cryoablation of
prostate cancer (
TCAP) at a community hospital is retrospectively reviewed. A series of 590 consecutive patients who underwent
TCAP as primary
therapy with curative intent for localized or locally advanced
prostate cancer from March 1993 to September 2001 were identified. Patients were stratified into 3 risk groups according to clinical characteristics. Biochemical disease-free survival (bDFS), post-
TCAP biopsy results, and post-
TCAP morbidity were calculated and presented. The mean follow-up time for all patients was 5.43 years. The percentages of patients in the low-, medium-, and high-risk groups were 15.9%, 30.3%, and 53.7%, respectively. Using a
prostate-specific antigen (PSA)-based definition of biochemical failure of 0.5 ng/mL, results were as follows: (1) the 7-year actuarial bDFS for low-, medium-, and high-risk patients were 61%, 68%, and 61%, respectively; (2) the bDFS probabilities for a PSA cutoff of 1.0 ng/mL for low-, medium-, and high-risk patients were 87%, 79%, and 71%, respectively; and (3) the bDFS probabilities for low-, medium-, and high-risk patients using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition of biochemical failure (3 successive increases of PSA level) were 92%, 89%, and 89%, respectively. The rate of positive biopsy was 13%. After a positive biopsy, 32 patients underwent repeat
cryoablation. For those patients who underwent repeat
cryoablation, 68%, 72%, and 91% remain bDFS using definitions of 0.5 ng/mL, 1.0 ng/mL, and the ASTRO criteria, respectively, after a mean follow-up time since repeat
cryoablation of 63 months. The rates of morbidity were modest, and no serious complications were observed.
TCAP was shown to equal or surpass the outcome data of external-beam radiation, 3-dimensional conformal radiation, and
brachytherapy. These 7-year outcome data provide compelling validation of
TCAP as an efficacious treatment modality for locally confined and locally advanced prostatic
carcinoma.