CRYOABLATION INDICATIONS

Prostate cancer

Prostate cancer overview

Prostate cancer is the third most common cancer worldwide (7.3% of total new cases in 2020), with an incidence rate that varies according to geography from 6.3 to 83.4 per 100,000 men. The highest rates are found in Northern (83.4 per 100.000) and Western Europe (77.6 per 100.000). It is the second most common cancer in men and the fifth leading cause of cancer death.¹

Prostate cancer occurs when cells inside the prostate gland start to grow out of control, and, in the majority of cases, it is diagnosed as adenocarcinoma.²

Depending on how far the disease has progressed, prostate cancer is staged from I through IV: ³

Stage I: cancer is on one side of the prostate;
Stage II: cancer has spread but it remains confined to the prostate gland;
Stage III: cancer is in both sides of the prostate (3A), or it has spread outside the prostate gland to nearby tissues (3B, 3C)
Stage IV: cancer has reached the lymph nodes or has spread to other body parts.

On this page

Prostate cancer overview

Subtypes and use of cryoablation

Treatment options

Clinical results – why cryoablation?

Our cryoablation solutions

2^nd

Prostate cancer is the 2^nd most common type of cancer and the 5th leading cause of cancer death among men.¹

65-74 years

Prostate cancer is most often diagnosed in men who are aged 65-74 years; median age at diagnosis is 66 years.⁶

Prostate cancer subtypes and use of cryoablation

More than 95% of primary prostate cancers are adenocarcinomas, with the acinar adenocarcinoma (AAC) being the most common type.^2,5

Acinar adenocarcinoma (AAC) is the main subtype of prostate cancer. It develops in the cells that line the prostate gland and mostly occurs in men aged over 60.^A,B

Incidence: ~90%^A

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G

Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H

A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Although rare, ductal adenocarcinoma (DAC) is the second most common subtype of prostatic cancer.^C It develops in the cells that line the ducts (tubes) of the prostate gland and it grows and spreads more quickly than AAC.^A,B It usually occurs in men aged between 63 and 72.^D

Incidence: ~5%^C

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G

Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H

A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Neuroendocrine carcinoma can start in neuroendocrine cells anywhere in the body, rarely in the prostate.^B

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Transitional cell cancer usually starts in the urethra or bladder and spreads to the prostate; it can rarely start in the prostate.^E

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Neuroendocrine carcinoma can start in neuroendocrine cells anywhere in the body, rarely in the prostate.^B

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Transitional cell cancer usually starts in the urethra or bladder and spreads to the prostate; it can rarely start in the prostate.^E

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Small-cell carcinomas accounts for ~1% of prostate cancers. It grows in small round cells in the prostate and can spread very quickly.^E

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Squamous cell carcinoma is a rare (<1%) and aggressive form of prostate cancer which develops in the flat cells that cover the prostate glands.^B,E

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Soft-tissue prostate cancer is extremely rare (<0.1% of the cases).^B It tends to develop in the soft tissue outside the prostate gland.^E

Incidence: <5%^B (very rare)

Use of cryoablation:

Cryoablation has demonstrated excellent outcomes both as a local primary treatment for early-stage prostate cancer and as a strong local
salvage therapy.^F, G
Nance M.E, et al. report two successful cases of cryoablation used as salvage therapy for recurrent prostate cancer (adenocarcinoma and squamous cell carcinoma), describing it as a treatment able to provide local tumour control.^H
A recent case study has demonstrated MRI-guided whole-gland cryoablation to be an effective alternative option to treat prostatic adenocarcinoma for patients who had prior pelvic surgery.^I

Treatment options

Despite innovation in medical research and increasing levels of awareness, prostate cancer is still is one of the most commonly diagnosed cancer in men.¹

The physician’s decision on the best treatment option for prostate cancer depends on a variety of factors, including the tumour’s progression (stage and grade) and the severity of the cancer (low-risk, intermediate- risk, high-risk). In general, the most common options for treating prostate cancer are^7,8:

Local treatments:

Active surveillance
Surgery (radical prostatectomy)
Radiation therapy
Focal therapy (cryoablation)

Systemic treatments:

Hormone therapy
Targeted therapy
Immunotherapy
Chemotherapy

Cryoablation has been recently recognised by the European Association of Urology (EAU) to be a valuable alternative treatment for localised, whole-gland primary prostate cancer, providing significant improvements in patients’ quality of life.⁷

In addition, the ESMO association suggests cryoablation is a strong local salvage therapy.⁴

Clinical results – why cryoablation?

Explore cryoablation as primary treatment for prostate cancer

“Focal therapy [cryoablation] offers a middle ground between these extremes [radical prostatectomy and active surveillance] by precisely targeting only the cancer-bearing part of the gland while preserving the remainder of the prostate and its delicate surrounding structures.”

Lebastchi A.H et al, 2021¹²

Cryoablation has been shown to be an effective primary therapy for localised prostate cancer, both if adopted as whole-gland treatment and as a focal therapy option.^7,8,9,10,11

In particular, it has demonstrated excellent outcomes in terms of oncologic control ^12,13,14and preservation of erectile function^14,15,16; cryoablation also leads to low incontinence rates^16,17,18 and a short hospital stay.^15,17

High disease control rates
Preservation of erectile function
Fast recovery times
Low incontinence rates

Explore cryoablation as a salvage treatment for prostate cancer

“Focal salvage cryotherapy has managed to provide oncological control and maintain this patient’s quality of life in his later years”

Taimur T Shah, 2020 Charing Cross Hospital, Imperial College Healthcare NHS Trust and Imperial College London (ICL)

Cryoablation is not only a successful primary therapy for prostate cancer, but it is also able to control tumours resistant to other therapies.^14,20

In recent years, it has been recognised to be an effective and repeatable²² treatment option for patients failing primary therapy, providing excellent survival outcome (74% at 5 years) and low morbidity.^17,21

Low morbidity
Repeatable procedure
High survival rates

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References:

1. Sung H, Ferlay J, Siegel R.L, et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Asc Journals, Volume71, Issue3, May/June 2021, Pages 209-249. doi: 10.3322/caac.21660
2. Ranasinha N, Omer Y, Philippou Y, et al. (2021) Ductal adenocarcinoma of the prostate: A systematic review and meta-analysis of incidence, presentation, prognosis, and management. BJUI Compass. 2. doi: 10.1002/bco2.60
3. Prostate cancer stages. The information on this page was reviewed and approved by Maurie Markman, MD, President, Medicine & Science at CTCA. Last update on October 27, 2021. Available at: https://www.cancercenter.com/cancer-types/prostate-cancer/stages
4. Parker C, Castro E, Fizazi K, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020 Sep;31(9):1119-1134. doi: 10.1016/j.annonc.2020.06.011
5. Collins, S. Types of Prostate Cancer. 2021 WebMD, LLC. Medically reviewed by Smith, M.W on May 17, 2021. Available at: https://www.webmd.com/prostate-cancer/types-prostate-cancer#1-3
6. Tracy C.R. 2021. Prostate Cancer. Available at: https://emedicine.medscape.com/article/1967731-overview
7. Mottet N, Cornford P, Van der Berrgh R.C.N, et al. EAU - EANM - ESTRO - ESUR – SIOG Guidelines on Prostate Cancer. European Association of Urology 2020. Eur Urol. 2021 Feb;79:243-282. Available at: https://uroweb.org/wp-content/uploads/EAU-EANM-ESTRO-ESUR-SIOG-Guidelines-on-Prostate-Cancer-2020.pdf
8. The American Cancer Society medical and editorial content team. 2019. Treating Prostate Cancer. Available at: https://www.cancer.org/cancer/prostate-cancer/treating.html
9. Oishi M, Inderbir S.G, Ashrafi A.N, et al (2018). Primary Whole-gland Cryoablation for Prostate Cancer: Biochemical Failure and Clinical Recurrence at 5.6 Years of Follow-up. European Urology. 75. 10.1016/j.eururo.2018.09.004
10. Wang A, O'Connor LP, Yerram NK, Nandanan N, Ahdoot M, Lebastchi AH, Gurram S, Chalfin H, Pinto PA. Focal therapy for prostate cancer: recent advances and future directions. Clin Adv Hematol Oncol. 2020 Feb;18(2):116-125. Available at: https://www.hematologyandoncology.net/archives/february-2020/focal-therapy-for-prostate-cancer-recent-advances-and-future-directions/
11. Ellis DS, Manny TB Jr, Rewcastle JC. Cryoablation as primary treatment for localized prostate cancer followed by penile rehabilitation. Urology. 2007 Feb;69(2):306-10. doi: 10.1016/j.urology.2006.10.024
12. Lebastchi AH, Gill IS, Abreu AL. A Focus on Focal Therapy for Prostate Cancer. JAMA Surg. 2021;156(9):881–882. doi:10.1001/jamasurg.2021.3181
13. Sze C, Tsivian E, Tay KJ, et al. Anterior gland focal cryoablation: proof-of-concept primary prostate cancer treatment in select men with localized anterior cancers detected by multi-parametric magnetic resonance imaging. BMC Urol. 2019 Dec 5;19(1):127. 10.1186/s12894-019-0562-5
14. Tay KJ, Schulman AA, Sze C, et al. New advances in focal therapy for early stage prostate cancer. Expert Rev Anticancer Ther. 2017 Aug;17(8):737-743. doi: https://doi.org/10.1080/14737140.2017.1345630
15. Bahn D, de Castro Abreu AL, Gill IS, et. al. Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years. Eur Urol. 2012 Jul;62(1):55-63. doi: https://doi.org/10.1016/j.eururo.2012.03.006
16. Mendez M.H, Passoni N.M, Pow-Sang J, et al. Comparison of Outcomes Between Preoperatively Potent Men Treated with Focal Versus Whole Gland Cryotherapy in a Matched Population. Journal of Endourology, Vol. 29, No. 10. Oct 2015. 1193-1198. 10.1089/end.2014.0881
17. Mercader C, Musquera M, Franco A, et al. Primary cryotherapy for localized prostate cancer treatment. Aging Male. 2020 Dec;23(5):1460-1466. doi: 10.1080/13685538.2020.1796960.
18. Barqawi AB, Stoemenova D, Krughoff K et al. Targeted Focal Therapy for the Management of Organ Confined Prostate Cancer. J Urol. 2014; 192(3): 749-53. doi: 10.1016/j.juro.2014.03.033
19. Tay KJ, Polascik TJ, Elshafei A, et al. Propensity score-matched comparison of partial to whole-gland cryotherapy for intermediate-risk prostate cancer: an analysis of the cryo on-line data registry data. J Endourol 2017; 31:564–571. 10.1089/end.2016.0830
20. Leslie SW, Soon-Sutton TL, Sajjad H, et al. Prostate Cancer. [Updated 2021 Sep 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470550/
21. Wenske S, Quarrier S, Katz AE. Salvage cryosurgery of the prostate for failure after primary radiotherapy or cryosurgery: long-term clinical, functional, and oncologic outcomes in a large cohort at a tertiary referral centre. Eur Urol. 2013 Jul;64(1):1-7. doi: 10.1016/j.eururo.2012.07.008
22. Boissier R, Sanguedolce F, Territo A, et al. Partial salvage cryoablation of the prostate for local recurrent prostate cancer after primary radiotherapy: Step-by-step technique and outcomes. Urology Video Journal, Volume 7, 2020, 100040. doi: 10.1016/j.urolvj.2020.100040

A. Ranasinha N, et al. 2021. See resource n. 2
B. Collins, S. 2021. See resource n. 5
C. Baig FA, Hamid A, Mirza T, Syed S. Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization. Oman Med J. 2015;30(3):162-166. doi:10.5001/omj.2015.36
D. Liu T, Wang Y, Zhou R, et al. The update of prostatic ductal adenocarcinoma. Chin J Cancer Res. 2016 Feb; 28(1): 50–57. doi: 10.3978%2Fj.issn.1000-9604.2016.02.02
E. Markman M. Prostate cancer types. Cancer Treatment Centers of America. Page updated on September 21, 2021. Available at: https://www.cancercenter.com/cancer-types/prostate-cancer/types
F. Parker C, et. al. 2021. ESMO Guidelines for Prostate Cancer. See resource n. 4
G. Mottet N, et al. 2021. EAU Guidelines for Prostate Cancer. See resource n. 7
H. Nance M. Image-guided percutaneous cryo-ablation of peri-urethral unresectable recurrent pelvic malignancy: A case report and brief review. Radiology Case Reports, Volume 16, Issue 5, 2021. Pages 1227-1232. doi: 10.1016/j.radcr.2021.02.055
I. Kinsman KA, White ML, Mynderse LA, et al. Whole-Gland Prostate Cancer Cryoablation with Magnetic Resonance Imaging Guidance: One-Year Follow-Up. Cardiovasc Intervent Radiol. 2018;41(2):344-349. doi: 10.1007%2Fs00270-017-1799-6

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