Thomas J. Polascik, MD, FACS, presented “Focal Prostate Cryotherapy” during the 25th Annual Southwest Prostate Cancer Symposium conference on December 11, 2021, in Scottsdale, Arizona.
How to cite: Polascik, Thomas J. “Focal Prostate Cryotherapy.” December 2021. Accessed Jul 2024. https://grandroundsinurology.com/focal-cryosurgery-outcomes-and-observations/
Focal Prostate Cryotherapy – Summary
Thomas J. Polascik, MD, FACS, Professor of Surgery at Duke University and Director of Surgical Technology at the Duke Prostate and Urological Cancer Center, discusses focal prostate cryotherapy and recent data on the treatment’s outcomes. He begins by describing the ideal patient for focal cryotherapy as someone with a greater than ten-year life expectancy and single or multiple mpMRI-visible, biopsy-proven Gleason Grade 2 prostate cancer (PCa) in locations amenable to ablation. Dr. Polascik outlines the procedure and states that the goals of the treatment are eradication of PCa, avoiding urinary and sexual dysfunction, and being a fast and simple outpatient procedure. He then begins discussing data on focal cryotherapy that shows that vitamin D3 functions as a sensitizer to cryoablation and that it is reasonable to re-treat about 20% of PCa patients with focal therapy. Dr. Polascik reviews the latest cryotherapy outcomes that all show focal cryotherapy to be approaching 100% rates of metastasis-free survival, cancer-specific survival, and urinary continence. He summarizes several studies that also show continence to be at about 95-100%, while potency was shown to be between 40-80%. Dr. Polascik then considers a study of long-term outcomes of focal therapy for low-intermediate risk cancer that found focal cryotherapy capable of increasing the time until radical or systemic therapy. He summarizes another study on anterior gland focal cryoablation showing that it can be effective based on erectile function and International Prostate Symptom Score (IPSS) not changing post-treatment. Dr. Polascik discusses expert consensus on how to surveil focal cryotherapy patients post-op, focusing on how in-field failure is a sign of poor treatment while out-of-field failure signals poor patient selection. He concludes by giving an overview of the Focal Therapy Society and by considering the future of focal cryotherapy.
About the 25th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, and Richard G. Stock, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Thomas J. Polascik, MD, FACS, is Professor of Surgery at Duke University Medical Center and the Director of Surgical Technology at the Duke Prostate and Urological Cancer Center. He is the Founder and Co-Director of the International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, which began at Duke in 2008. Dr. Polascik is the Editor of Imaging and Focal Therapy of Early Prostate Cancer. He is Founder and President of the Focal Therapy Society, as well as Director of Duke’s Society of Urologic Oncology Fellowship Training Program and the Genitourinary Program on Focal Therapy at the Duke Cancer Institute. He is the Medical Director of Duke’s Men’s Health Initiative Screening Event and is a governing member of several medical boards and societies. His clinical and research interests focus on prostate and kidney cancer. He has authored over 350 peer-reviewed manuscripts and book chapters.
