Propensity Score Comparative Matching of Oncological and Functional Outcomes of Primary Focal vs Whole Gland Cryotherapy for Prognostic Grade Groups (PGG) 4 and 5 Prostate Cancer
To compare the oncologic and functional outcomes of partial vs whole-gland cryotherapy for men with high grade PGG 4-5 prostate cancer.
A 1:5 matched comparison of men with PGG 4-5 (Gleason score 8-10) prostate cancer treated with partial gland (targeted ablation, unilateral/bilateral nerve-sparing ablations) or whole gland prostate cryotherapy in the primary setting were included. A propensity score was developed based on age, prebiopsy serum prostate-specific antigen, biopsy Gleason score and clinical stage. Outcomes include oncological control defined by biochemical progression-free survival (BPFS) using Phoenix criteria, and positive post-cryo biopsy rates. Functional outcomes assessed were urinary retention, 12-month urinary continence (defined as strictly pad-free), and sexual function (patient reported, with/without intervention, potency sufficient for sexual intercourse).
Overall 546 men were identified. Post matching, 312 men were analyzed (52 partial gland and 260 whole gland) with mean follow-up 40± 37.4 months. There were no statistically significant differences between the 2 matched groups regarding median age (70 vs. 72, p=0.2), median pretreatment PSA (6.2 vs. 6.3 p= 0.3), Gleason score > 8 (19.2% vs. 21.9% P=0.67), neoadjvant therapy (41.2% vs.45.6%, P=0.57), clinical stage ≥ T2b (32.4% vs. 44.5%, p=0.17) and median prostate volume (32 vs. 32.3cc, p=0.67) for partial and whole gland primary cryoablation, respectively. The 2/5-year BPFS rate was 88.5% / 69.2% for partial-gland vs 72.6 /52.7% for whole gland ablation (p = 0.10, Figure1). The 12-month continence rate was 100% vs 96.4% (p = 0.17), the 12-month rate of effective intercourse was 73.3% vs. 29.3% (p
Men with high-grade prostate cancer treated with primary partial prostate cryoablation are more likely to maintain sexual function while having comparable oncological and functional outcomes to whole gland therapy.