Standard versus saturation biopsy before primary focal cryosurgery of the prostate: Does it matter?
123 Background: Primary focal cryosurgery (PFC) has emerged as a viable option for local therapy in prostate cancer (PCa), most suitable for patients with clinical stage T1c-T3 disease of any tumor grade in whom potency is not of primary concern and who are not suitable for radical prostatectomy or radiation therapy. Success of 5-year biochemical recurrence (BCR)-free survival, depending on criteria, ranges from 60% to 90% in the literature. We hypothesize that saturation biopsy before PFC leads to lower rates of BCR compared to standard 12-core biopsy. Methods: We compiled a consecutive series of patients who underwent PFC at our institution for localized PCa. Parameters including demographics, PSA levels, and Gleason scores before primary treatment and at time of recurrence were assessed. Biochemical failure was defined by both Phoenix (PD) and Stuttgart (SD) definitions. Chi-square analysis was performed to compare outcomes. Results: One hundred and forty-seven patients underwent PFC at our institution between August 2000 and January 2014. Forty-five patients were excluded due to incomplete follow-up data and/or missing biopsy information. Median follow-up was 40.3 months (0.8-116, IQR 41). Conclusions: Zero of the six patients who underwent a saturation biopsy before PFC experienced biochemical failure or progression. This in contrast to those who underwent a standard 12-core biopsy before PFC, of which 19% experienced biochemical failure by PD and 26% by SD, and 6% underwent progression. This may be due to more informed selection for local therapy and more comprehensive assessment of the extent of tumor for treatment planning. Though these differences were not statistically significant in our study, we believe that our results lay the groundwork for a larger study to assess differences in outcomes after PFC depending on the extent of biopsy before treatment. [Table: see text]