Radical prostate cancer treatment in the elderly: role of cryotherapy| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

Background and 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.