Radical prostate cancer treatment in the elderly: role of cryotherapy

G. Silecchia 1, O. Selvaggio 1, G. Stallone 2, F. Lugnani 3, A. Hoznek 4, G. Carrieri 1

1 Urology and Renal Transplantation Unit; Department of Medical and Surgical Sciences, University of Foggia, Italy; 2 Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy; 3 Department of Urology, Kirurski Sanatorij Ljubljana, Slovenia; 4 Department of Urology, Henri Mondor Hospital, Créteil, France

Background & Aims. Data regarding efficacy and safety of radical cryotherapy for localized prostate cancer in elderly men are lacking. This study aimed to determine oncological and functional outcomes of radical cryotherapy in this setting. 

Methods. From our dedicated Internal Review Board approved prospectively maintained database we selected elderly (> 75 years) patients with localized prostate cancer as assessed by a negative staging choline-PET. After cryotherapy, patients were seen at 1 month, every 3 months for the first two years, then every six months, for clinical examination, serum PSA, questionnaires for lower urinary tract symptoms (IPSS) and erectile function (IIEF-5), and assessment of pad usage for urinary continence. Biochemical recurrence was defined as a rising PSA above the Nadir of more than 2 ng/mL. Complications were scored using the Clavien-Dindo scale.

Results. From March 2012 to June 2018, 45 patients met the inclusion criteria. Mean postoperative hospital stay was for 1.06 days. At median follow-up (41 months), biochemical failure occurred in 8.8% of patients, with Kaplan-Meier plots showing an estimated 85% biochemical-free survival at 5y. Three (6.6%) patients reported urge urinary incontinence needing at least 2 pad/day; they were treated by antimuscarinic agents with complete symptoms resolution in 2 and relevant benefit in one. No patient suffered stress urinary incontinence. 

Conclusions. This is the first study testing radical cryoablation in the setting of elderly patient. It showed excellent 5y biochemical recurrence-free survival not only in intermediate-risk but also in high-risk patients at the price of a reasonable/low rate of minor complications.

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