Prior BPH surgery does not affect oncologic outcomes with prostate cryoablation

The risks of erectile dysfunction or rectourethral fistula post-cryosurgery were also not increased by prior surgical interventional therapy for benign prostatic hyperplasia.

Oncologic outcomes among patients receiving whole-gland prostate cryoablation were not negatively impacted by prior surgical interventional therapy for benign prostatic hyperplasia (BPH), according to results from a study published in Prostate Cancer and Prostatic Diseases.1

The investigators also found that, among patients who were sexually functional prior to cryoablation, the risks of erectile dysfunction or rectourethral fistula post-cryosurgery were not increased by prior BPH intervention. However, prior BPH surgery did increase the risk of urinary retention and incontinence after cryoablation.

Overall, the investigators reviewed data for 3831 men with prostate cancer who received primary whole-gland prostate cryoablation. Of these patients, 160 men had received BPH interventional therapy. The BPH treatments included transurethral resection of the prostate (145 patients), transurethral microwave thermotherapy (9 patients), and transurethral needle ablation (6 patients).

The study population did not include patients who had received medical treatment for BPH, or those whose BPH had been treated with unspecified therapy. Using statistical analyses, the investigators compared outcomes in men with prior BPH interventional therapy versus those without the intervention.

A Kaplan-Meier analysis showed that 5-year biochemical progression-free survival outcomes were not significantly different (P = .3), regardless of whether or not a patient had received interventional BPH therapy.

The investigators also examined local disease recurrence, which was assessed by post cryoablation positive for-cause prostate biopsy. The local disease recurrence rate was 25.4% among patients with prior BPH intervention compared with 28.7% for those without, a difference that was not statistically significant (P = .59). The risk of post-cryosurgery development of rectourethral fistula (P = .84) or new-onset erectile dysfunction (P = .08) was not higher in patients with prior BPH intervention.

Unadjusted analyses showed a post-cryosurgery urinary retention rate of 17.5% among patients with prior BPH intervention versus 9.6% among those without (P = .001). The new onset incontinence rates were 39.9% versus 19.4%, respectively (P >.001). Multivariable regression also showed that the risk of urinary retention was 1.9 times more likely in patients with prior BPH intervention and the risk of new-onset urinary incontinence was 2.13 times higher.

The National Cancer Institute defines cryoablation as, “A procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue. A cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas.”2

Although it is not as well established as surgery or radiation, cryoablation is an option for treating patients with localized prostate cancer. Side effects that occur with the technique in some patients include incontinence or obstructed urine flow, loss of sexual function, or harm to the rectum.

References

1. ElShafei A, DeWitt-Foy M, Calaway A, et al. Does prior surgical interventional therapy for BPH affect the oncological or functional outcomes after primary whole-gland prostate cryoablation for localized prostate cancer [published online January 22, 2021]? Prostate Cancer Prostatic Dis. doi: 10.1038/s41391-020-00306-z

2. National Cancer Institute. Cryosurgery in Cancer Treatment. Reviewed September 10, 2003. Accessed January 27, 2020. https://bit.ly/3opGlsC.