Third-Generation Salvage Cryotherapy for Radiorecurrent Prostate Cancer: A Centre’s Experience

Abstract

Introduction: The experience of a tertiary centre in the management of recurrent prostate cancer after radiotherapy by salvage cryotherapy is presented. Patients and Methods: Between February 2006 and August 2008, 19 patients underwent salvage cryotherapy for radiorecurrent prostate cancer. Post-radiotherapy recurrence was confirmed by prostatic biopsy. The ‘Phoenix definition’ was used to define biochemical failure after salvage cryotherapy. Results: The mean age at cryotherapy was 69.2 years and the mean time from radiotherapy to cryotherapy was 72.3 months. Patient characteristics prior to cryotherapy included a mean PSA level of 6.84 ng/ml and a median Gleason score of 7. The mean post-cryotherapy follow-up was 33.3 months. The 2-year biochemical disease-free survival rate was 58%. The median post-cryotherapy PSA nadir was 0.20 ng/ml (range 0.005–8.260). There were no procedure-related or cancer-related deaths. Complications included incontinence (10.5%), erectile dysfunction (89%) and fistula formation (5.3%). Conclusions: The relatively high rates of biochemical response support the use of cryotherapy as a salvage procedure for radiorecurrent prostate cancer.

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

“…Only 1.5% of patients in the entire cohort in this analysis developed fistulas. This is consistent with previous published morbidity data [8,9,15,18]. Two of the six patients that developed a fistula had undergone lowdose-rate brachytherapy as primary treatment, followed by two subsequent SCs.…”

“…Median primary and secondary adapted Gleason score and Gleason sum after RT (as interpretation of Gleason grading after RT is limited) were significantly less favourable in patients who died overall, as compared to patients that were still alive at last follow-up (4 [3][4][5] [6][7][8][9][10]; p < 0.01), a finding that could not be shown for patients who died of disease, or whose disease recurred. This result was also reflected in univariate analyses, where higher adapted Gleason score and Gleason sum were significantly associated with worse OS ( p < 0.01).…”

“…Several recent publications have demonstrated an improvement in functional and oncologic outcomes with improved technology [8][9][10].…”

High-Intensity Focused Ultrasound and Cryotherapy as Salvage Treatment in Local Radio-Recurrent Prostate Cancer

“…Data from our institution have shown a DFS rate at 10 years of between 39 and 64% with presalvage PSA <5 ng/ml and presalvage Gleason score ≤7 being the best predictor of disease-free recurrence at 10 years [32]. Recently, Philippou et al [33] have reported a DFS rate at 2 years of 58% with a median PSA nadir of 0.20 ng/ml. A summary of available studies is included in table 3.…”

“…With improvements in CRYO devices and techniques, the incidence of complications has decreased with time. Urinary incontinence rates ranging from 10.5 to 36% [21,33] in comparison to incontinence rates of 41% reported in salvage RP, whilst the fistula rates were from 2.6 to 5.3% [22,33], have been reported with CRYO in comparison with rectal injury rates from 2 to 15% with salvage RP. The risk of complications seems to be higher in the presence of prior transurethral surgery.…”