Current Status of Local Salvage Therapies Following Radiation Failure for Prostate Cancer

Abstract

Salvage prostatectomy for localized radiation failure is a good option in the patient with a life expectancy of at least 10 years, preradiation and preoperative prostate specific antigen less than 10 ng/ml, and localized preoperative stage with the understanding that complication risks are higher. Salvage cryotherapy is a valid option in patients with preoperative prostate specific antigen less than 10 ng/ml and Gleason score less than 8, clinical stage less than T3 who are hormonally naive. Salvage cryotherapy is especially suited for older patients with some comorbidities who are still considered to be at reasonable anesthetic risk. The study of brachytherapy remains in its infancy and the efficacy of this modality remains to be determined.

Targeted induction of apoptosis via TRAIL and cryoablation: a novel strategy for the treatment of prostate cancer

“…3,4 Indeed, a recent study indicates an average recurrence rate of 25-35% (up to 93% in one group) following radiation therapy. 5 Recent scientific and technological advances offer alternatives to these treatment options for CAP with an emphasis on more minimally invasive therapies. 6,7 Cryosurgery has emerged as one of the many tools available for the treatment of CaP.…”

“…6,7 Cryosurgery has emerged as one of the many tools available for the treatment of CaP. 5,8 This procedure utilizes the destructive forces of low temperature to ablate unwanted tissue. [9][10][11][12] The center (nearest the cryoprobe) of the cryogenic legion is rendered completely necrotic, but as temperatures elevate further from the probe tip, less is known about the mechanisms of cell death and survival.…”

Cryoablation of the prostate: technical recommendations

“…[12][13][14][15] It has been noted that the use of cryosurgery after radiation failure resulted in lower biochemical relapse rates than those achieved with salvage radical prostatectomy after radiation failure. 15 Five-year biochemical relapse-free rates of 55-69% [16][17][18][19] are reported with salvage radical prostatectomy, whereas rates after salvage cryotherapy vary according to the definition used, but are generally lower. 15,20 Complication rates with salvage cryosurgery have been shown to be higher than with primary cryosurgery, particularly for incontinence rates and pelvic pain.…”

“…15 Five-year biochemical relapse-free rates of 55-69% [16][17][18][19] are reported with salvage radical prostatectomy, whereas rates after salvage cryotherapy vary according to the definition used, but are generally lower. 15,20 Complication rates with salvage cryosurgery have been shown to be higher than with primary cryosurgery, particularly for incontinence rates and pelvic pain. 15 Cryotherapy is also considered to have potential as a palliative therapy in patients with locally advanced cancer, providing pain relief for up to 6 months.…”

“…15,20 Complication rates with salvage cryosurgery have been shown to be higher than with primary cryosurgery, particularly for incontinence rates and pelvic pain. 15 Cryotherapy is also considered to have potential as a palliative therapy in patients with locally advanced cancer, providing pain relief for up to 6 months. 21 In our personal experience, patients failing cryotherapy can undergo a repeat procedure with rarely an increased risk of side effects.…”