Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy?

Nair, Shiva M.; Warner, Andrew; Lavi, Arnon; Rodrigues, George; Chin, Joseph L.

doi:10.5489/cuaj.6676

Cited by 3 publications

(9 citation statements)

References 24 publications

(32 reference statements)

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“…Among the 26 studies [23][24][25][26][27][28][29][30][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] included (Table 3…”

Section: Resultsmentioning

confidence: 99%

“…In 11 studies, 2,101 patients (age range 56-79 years) underwent salvage cryotherapy with the PSA ranging from 0.01 to 31.60 ng/mL. Nine studies [30,[37][38][39]41,45,46,49,54] reported histological staging, and one study [54] reported 7 as the median Gleason score. The remaining studies [51,53] encompassed 536 patients with PSA < 7 ng/mL, 478 patients with PSA = 7 ng/mL and 378 patients with PSA > 7 ng/mL.…”

Section: Salvage Cryotherapy Studiesmentioning

confidence: 99%

“…The remaining studies [51,53] encompassed 536 patients with PSA < 7 ng/mL, 478 patients with PSA = 7 ng/mL and 378 patients with PSA > 7 ng/mL. For the D'Amico risk classification, three studies [37,49,51] included 67 low-risk patients, 121 intermediate-risk patients and 87 high-risk patients. Three studies [30,46,49] reported patient radiological staging, with 222 patients classified as stage T1, 356 patients as T2, 90 patients as T3 and 11 patients as T4.…”

Section: Salvage Cryotherapy Studiesmentioning

confidence: 99%

“…For the D'Amico risk classification, three studies [37,49,51] included 67 low-risk patients, 121 intermediate-risk patients and 87 high-risk patients. Three studies [30,46,49] reported patient radiological staging, with 222 patients classified as stage T1, 356 patients as T2, 90 patients as T3 and 11 patients as T4. Lastly, patients were followed-up after salvage therapy from 9.0 to 297.6 months.…”

Section: Salvage Cryotherapy Studiesmentioning

confidence: 99%

“…For oncological outcomes, six studies [37,39,41,46,49,51] reported the cancer-specific survival rate from 65.5% to 100.0%. Two studies [45,53] reported the range of biochemical-free survival from 48.1% to 58.1%, whereas one study [30] reported an ADT-free survival rate of 71.3%.…”

Section: Primary Outcomes In Salvage Cryotherapy Studiesmentioning

confidence: 99%

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Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

Chin¹,

Lynn²

2022

Cureus

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Cryotherapy is one of the recognised ablative modalities for both primary and salvage therapy for prostate cancer. It presents an alternative, less invasive treatment for an organ-confined disease, improved preservation of surrounding tissue and a more suitable option for patients who are unfit for radical prostatectomy. Nevertheless, the currently available literature is relatively too scarce to provide definite conclusions regarding the treatment outcomes in cryotherapy. The present study aimed to review current oncological and survival outcomes in cryotherapy for primary and recurrent prostate cancer. Furthermore, this study aimed to establish the complications and functional outcomes of cryotherapy for prostate cancer. A literature search was performed on the PubMed, Cochrane and Google Scholar databases. Current guidelines and recommendations from the European Association of Urology were also reviewed. The search keywords used included 'Cryotherapy, Prostate Cancer', 'Cryoablation, Prostate Cancer' and 'Cryosurgery, Focal Prostate Cancer'. Truncations and Boolean operators were used with the keywords. All relevant studies from after 2015, including abstracts and non-English research assessing oncological and functional outcomes and complications, were included. Twenty-six studies consisting of 11,228 patients were reviewed. Fifteen studies assessed the outcomes of primary cryotherapy, whereas 11 studies reported the outcomes in salvage therapy. The patient's age ranged 55-85 years, and the pre-procedural prostate-specific antigen (PSA) ranged 0.01-49.33 ng/mL. A total of 2031 patients were classified to be at low risk, 2,995 were at moderate risk and 253 were at high risk on the D'Amico prostate cancer risk classification system. Followups ranged from 9.0 to 297.6 months. The disease-specific survival rate was 65.5%-100.0%, overall survival was 61.3%-99.1%, the PSA nadir was 0.01-2.63 ng/mL and the overall biochemical recurrence rate was 15.4%-62.0%. The complications included erectile dysfunction (3.7%-88.0%), urinary retention (2.13%-25.30%) and bladder neck stricture/stenosis (3.0%-16.7%). The functional assessment showed a mixture of improved, unchanged or worsened post-procedural outcomes in primary therapy. This systematic review did not find significant differences in the cancer-specific, overall and biochemical-free survival rate between the primary and salvage cryotherapy cohorts. The most common complications encountered in both cohorts were erectile dysfunction, urinary incontinence, lower urinary tract/bladder neck stricture and infection. More prospective and double-arm studies are critically needed to provide guidance on the careful selection of patient cohorts for cryotherapy, whether for curative or salvage intent.

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“…Among the 26 studies [23][24][25][26][27][28][29][30][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] included (Table 3…”

Section: Resultsmentioning

confidence: 99%

Section: Salvage Cryotherapy Studiesmentioning

confidence: 99%

Section: Salvage Cryotherapy Studiesmentioning

confidence: 99%

Section: Salvage Cryotherapy Studiesmentioning

confidence: 99%

Section: Primary Outcomes In Salvage Cryotherapy Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

Chin¹,

Lynn²

2022

Cureus

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Salvage ablation for locally recurrent prostate cancer

Lomas¹,

Woodrum

Mynderse³

2021

Current Opinion in Urology

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Purpose of reviewThis review aims to summarize the latest evidence for the use of salvage ablation of localized prostate cancer recurrences after primary therapy radiotherapy or prostatectomy.Recent findingsSavage ablation represents a treatment option in select patients with localized recurrences following primary therapy of prostate cancer. Following radiotherapy, salvage cryotherapy and high-intensity focused ultrasound (HIFU) demonstrate encouraging oncologic outcomes. Biochemical recurrence-free survival ranged from 71% at 2 years to 44.2% at 10 years for cryotherapy and from 51% at 5 years to 28.7% at 10 years for HIFU. Rates of adverse effects appear to be more favorable with ablation compared to salvage surgery. Focal salvage ablation may offer a further balance between oncologic control and adverse effects. Following radical prostatectomy, recent data on the use of salvage ablation of local recurrences are less robust with only a few small studies published in the last 2 years.SummarySalvage ablation is an option for localized disease recurrences following primary treatment. Its role is most established for postradiation recurrence. It can also be utilized in postprostatectomy recurrence, although published data is more limited. Future studies are needed to further explore the role of ablation in both cohorts.

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Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies

Faiella,

Santucci,

D’Amone

et al. 2024

Cancers

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Background: Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. Methods: Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. Results: Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. Conclusions: The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa.

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Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy?

Cited by 3 publications

References 24 publications

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

Salvage ablation for locally recurrent prostate cancer

Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies

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