141 - MRI-Guided Cryoablation for Primary and Salvage Prostate Cancer Treatment: Initial Patient Experience

Purpose: To evaluate the efficacy of cryoablation for primary and recurrent prostate cancer (PCa), tracking prostate-specific antigen (PSA) levels and morbidities.

Materials and Methods: At the University of Wisconsin-Madison, 42 patients underwent MRI-guided prostate cryoablation between 2022 and 2025 using previously reported techniques {1}. Cryoablation was used as a minimally invasive treatment for both primary and recurrent prostate cancer due to its low risk of morbidity, especially valuable for salvage therapy2}. Patients with biopsy-proven, focal or nondiffuse multifocal PCa were cryoablation candidates.



Demographic, clinical, and procedural data were analyzed. Mean patient age was 72.2±6.4 years; mean BMI was 30.6±6.0, and average smoking pack-years was 3.3±7.5. By race, 38 (90.7%) patients were white, 3 (7.0%) were black, and 1 (2.3%) was Asian. There were 19 (44.2%) patients with primary PCa and 23 (55.8%) with recurrent PCa. By Gleason score (GS), 1 case was GS6, 34 GS7, 3 GS8, and 3 GS9. Recurrence was monitored via serial PSA measurements and MRI or PET/CT imaging.



Post-cryoablation biochemical recurrence (BCR) was determined via Phoenix Criteria: PSA levels rising 2 ng/mL from the post-treatment nadir, as done in other work {3,4}.

Results: BCR was observed in 7 (16.6%) cases. In the 35 (83.3%) non-BCR cases, post-treatment PSA dropped by a significant (p< 0.05) 82% on average, with follow up monitoring showing no significant PSA increases.



In the 7 BCR cases, 5 showed recurrence outside of the treatment zone, suggesting microscopic, diffuse disease spread pre-treatment. Of the remaining 2, imaging showed local tumor progression, while 1 showed no evidence of disease on follow up imaging.



Long-term complications were assessed. Many patients had baseline erectile dysfunction (ED) and urinary symptoms pre-procedure. Notably, 2 patients experienced improved urinary symptoms post-cryoablation. Five (11.6%) patients reported a decrease in erectile function and five (11.6%) separate patients reported stress incontinence post-procedure.

Conclusion: MRI-guided prostate cryoablation offers safe, targeted, minimally invasive cancer control while sparing healthy structures, making it attractive for recurrent cancers, where treatment options are limited. It is also a great option for patients prioritizing urinary and sexual function or are poor surgical candidates as the outcomes have shown low morbidity with minimal reports of worsened ED and urinary symptoms.