Safety and efficacy of CT-guided cryoablation for recurrent prostate cancer

Tuesday, March 7, 2023

3:18 PM – 3:27 PM

Location: Phoenix Convention Center, 221AB

Presenting Author(s)

Vijay Ramalingam, MD

Vascular Interventional Radiologist
Beth Israel Deaconess Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

SD

Spencer Degerstedt, M.D.

Interventional Radiology Resident
Beth Israel Deaconess Medical Center
Marwan H. Moussa, M.D.

Vascular and Interventional Radiologist
Beth Israel Deaconess Medical Center
MA

Muneeb Ahmed, MD FSIR

Chief, Division of Interventional Radiology
Beth Israel Deaconess Medical Center/Harvard

Disclosure(s):

Vijay Ramalingam, MD: No financial relationships to disclose

Muneeb Ahmed, MD FSIR: Agile Devices, Inc.: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing); Replimune, Inc.: Consultant (Ongoing); RevOps Health, Inc.: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing)

Purpose: Treatment of focal recurrent prostate cancer following surgery or radiation remains a significant clinical challenge, particularly in patients who would like to minimize the side effects of long term hormonal or whole gland therapies. Percutaneous tumor ablation has been largely performed using MR-guidance to-date. Here, we report our preliminary experience using CT-guided cryoablation to treat focal recurrent prostate cancer.

Materials and Methods: This is a HIPPA compliant, IRB approved retrospective study of consecutive patients between 07/2020–09/2022 presenting with prostate cancer recurrence who underwent image-guided cryoablation. A total 19 patients met the inclusion criteria. Demographic details, pre- and post-ablation urinary, rectal, and erectile function assessment, procedure details, and pre-operative and post-operative imaging findings and prostate specific antigen (PSA) values were recorded. Data is provided as a mean ± standard deviation, and comparisons were made using students t-test.

Results: The mean treated tumor size was 15.7 ± 6.2 mm. Technical success was achieved in 18/19 (94.7%), with one procedure aborted due to inability to obtain a safe plane. The median follow-up time was 6.5 months (range 0.7-21). The mean PSA pre-ablation was 8.1 ± 9.3 and post-ablation was 2.6 ± 4.0 (p=0.002). Of the 15/19 patients that had post-operative imaging, 13/15 had no evidence of residual disease, and 2/15 patients had improved but persistent residual disease. Overall, 16/18 (88.9%) treated patients demonstrated a PSA and/or imaging response to ablation. There were no major complications, and 2/18 minor complications (pelvic neuralgia / urinary incontinence, and urinary urgency which resolved after pelvic physical therapy).

Conclusion: In this pilot study, CT-guided cryoablation is technically feasible, safe, and can successfully treat locally recurrent prostate cancer.