MRI-Guided Salvage Focal Cryoablation: A 10-Year Single-Center Experience in 114 Patients with Localized Recurrent Prostate Cancer

SIMPLE SUMMARY: Patients with localized recurrent prostate cancer (PCa) are typically treated with hormonal therapy, surgery (radical prostatectomy), or radiation therapy. These treatments are associated with serious side-effects such as incontinence and impotence. Magnetic resonance imaging (MRI)-guided focal cryoablation is an emerging treatment for this patient group. This therapy aims to treat the cancer selectively while preserving the rest of the prostatic gland and thereby minimizing the risk of treatment toxicity. Cryoablation promises to delay and potentially avoid the initiation of other salvage treatments. In this article, we investigate the ability to achieve disease control and to avoid the need for other salvage treatments afterwards. Our research provides long-term evidence on oncological and safety outcomes in a large group of patients treated with MRI-guided focal cryoablation. We also investigated the influence of prior treatment on patient outcomes. ABSTRACT: Patients with localized recurrent prostate cancer (PCa) are eligible for androgen-deprivation therapy, salvage radical prostatectomy (RP) or radiation therapy. These treatments are associated with serious side-effects, illustrating the need for alternative local treatment options with lower morbidity rates. All patients who underwent magnetic resonance imaging (MRI)-guided salvage focal cryoablation (SFC) with localized recurrent PCa between 2011–2021 (n = 114) were included. Two subgroups were formed: patients without (n = 99) and with prior RP (n = 15). We assessed the recurrence- (RFS) and treatment-free survival (TFS), measured from date of treatment to date of recurrence or initiation of additional salvage treatment, using Kaplan–Meier plots. Complications were reported using the Clavien–Dindo (CD) scale. Overall 1-year and 5-year RFS were 76.0% and 25.1%, and overall 1-year and 5-year TFS were 91.5% and 58.2%, respectively. Patients without prior RP showed a significantly higher 1-year (78.5% vs. 52.5%) and 5-year RFS (28.1% vs. 0.0%; p = 0.03), and a trend towards a higher 1-year (92.6% vs. 79.0%) and 5-year TFS (60.2% vs. 23.0%; p = 0.10) compared to those with prior RP. A total of 46 complications occurred in 37 patients, and the overall complication rate was 32.4% (37/114 patients). The majority (41/46; 89.1%) of complications were minor (CD 1–2). Overall (31.3 vs. 40.0%) and major (3.0 vs. 13.3%) complication rates were lower in patients without compared to those with prior RP, respectively. MRI-guided SFC is an effective and safe therapy for patients with recurrent PCa, and has proved to delay and potentially prevent the initiation of salvage treatments. Patients with locally recurrent PCa after prior RP had an increased risk of recurrence, a shortened time to additional treatment, and more complications compared to those without prior RP, which should be considered when selecting patients for SFC.