Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy

Pisters, Louis L.; Leibovici, Dan; Blute, Michael L.; Zincke, Horst; Sebo, Thomas J.; Slezak, Jeffrey M.; Izawa, Jonathan I.; Ward, John F.; Scott, Shellie M.; Madsen, Lydia T.; Spiess, Philippe E.; Leibovich, Bradley C.

doi:10.1016/j.juro.2009.04.006

Cited by 115 publications

(86 citation statements)

References 16 publications

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“…For example, no significant difference in PCa-specific survival at 5 years was found between salvage cryotherapy and salvage RP (96 vs. 98%, respectively; p = 0.283) [84]. The authors of this study concluded that young, healthy patients with BCR after RT should consider salvage RP as it offers superior biochemical disease-free survival compared with cryotherapy and may offer a better chance of cure.…”

Section: Management Of Post-rt Recurrencementioning

confidence: 96%

“…Salvage cryotherapy may be an alternative to salvage RP; however, despite improvements in complication rates [79-83], studies have shown disappointing results in terms of 5-year biochemical disease-free survival after cryotherapy [80, 82, 84]. For example, no significant difference in PCa-specific survival at 5 years was found between salvage cryotherapy and salvage RP (96 vs. 98%, respectively; p = 0.283) [84].…”

Section: Management Of Post-rt Recurrencementioning

confidence: 99%

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Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

et al. 2017

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How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Importantly, this prostate-specific antigen (PSA)-only recurrence is a surrogate neither of PCa-specific survival nor of overall survival. Physicians are therefore challenged with preventing or delaying the onset of clinical progression in those deemed at risk, while avoiding over-treating patients whose disease may never progress beyond PSA-only recurrence. Adjuvant therapy for radical prostatectomy (RP) or local radiotherapy (RT) has a role in certain at-risk patients, although it is not recommended in low-risk PCa owing to the significant side-effects associated with RT and androgen deprivation therapy (ADT). The recommendations for salvage therapy differ depending on whether BCR occurs after RP or primary RT, and in either case, definitive evidence regarding the best strategy is lacking. Options for treatment of BCR after RP are RT at least to the prostatic bed, complete or intermittent ADT, or observation; for BCR after RT, salvage RP, cryotherapy, complete or intermittent ADT, brachytherapy, high-intensity focused ultrasound (HIFU), or observation can be considered. Many patient- and cancer-specific factors need to be taken into account when deciding on the best strategy, and optimal management depends on the involvement of a multidisciplinary team, consultation with the patient themselves, and the adoption of an individualised approach. Improvements in imaging techniques may enable earlier detection of metastases, which will hopefully refine future management decisions.

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Section: Management Of Post-rt Recurrencementioning

confidence: 96%

Section: Management Of Post-rt Recurrencementioning

confidence: 99%

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

et al. 2017

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“…[21] A retrospective, non-randomised comparison of salvage CA (56 patients) with SRP (42 patients) showed that SRP was associated with significantly better rates of biochemical disease free survival (bDFC) and overall survival (OS) (at 5 years OS 85% for salvage cryotherapy versus 95% for SRP, p=0.001) but there was no difference in disease specific survival (DSS). [22] Variations in baseline characteristics between the two groups in this study may explain at least some of the differences in outcome. Retrospective analysis shows that patients with low risk disease at initial diagnosis or pre-salvage PSA less than 5ng/mL had 3-year and 10-year bDFS rates of 73% and 64% respectively but those with high risk disease or pre-salvage PSA over 5ng/mL had rates of 11% and 6.7%.…”

Section: Salvage Radical Prostatectomy (Srp) Following Ebrtmentioning

confidence: 84%

Emerging Treatments for Recurrent Prostate Cancer

Hanna

Jones

2015

Future Oncol.

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Despite radical treatment, many men with prostate cancer will develop recurrence of their disease. In an exciting era of new therapies for prostate cancer in general, we focus on how these will specifically benefit those men with recurrent disease. We consider salvage treatments aimed at those with local recurrence confined to the prostate gland, therapies for those presenting with metastatic recurrence and the approach to men presenting with a rising prostate-specific antigen but no demonstrable disease (M0). In general, men with recurrent disease are often under-represented in randomized clinical trials. Consequently, evidence to guide treatment for these men is often lacking and this needs to be addressed in order to improve and better define our approach to this problem in the future.

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“…Pisters et al [35] reported on a case-control comparative study comparing salvage CRYO with salvage RP, performed at separate institutions respectively. Unfortunately as with all case-control comparisons there was a degree of bias in the selection of patients.…”

Section: Cryotherapymentioning

confidence: 99%

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

2012

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Background: Salvage high-intensity focused ultrasound (HIFU) and cryotherapy (CRYO) have emerged as interesting alternatives in the treatment of local radio-recurrent prostate cancer. Currently, recommendations concerning the use of CRYO and HIFU in the salvage setting are still evolving. Aim: The objective of this review was to analyze the results from studies on CRYO and HIFU as salvage treatment in local radio-recurrent prostate cancer. Materials and Methods: A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was conducted from 1993 to 2011 using medical subject headings ‘High-Intensity Focused Ultrasound’, ‘Cryotherapy’, ‘Local Radio-Recurrent’ and ‘Prostate Cancer’. Results: In the past years, there have been several published series demonstrating promising acceptable morbidity and oncological outcomes in the short term for HIFU and in the intermediate term for CRYO. The introduction of newer-generation devices and technical modifications has facilitated reduction of complications associated with the procedures. As with any salvage treatment, careful patient selection and subsequent follow-up are principal points. Conclusions: HIFU and CRYO are promising salvage treatments in patients with local radio-recurrent prostate cancer. The risk of significant complications in the salvage setting is higher compared with primary therapy; therefore, the patients must be informed about the risk of complications and the modality of treatment. However, only further evaluation in formal prospective clinical trials will hopefully confirm their role in clinical practice.

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Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy

Abstract: Young, healthy patients with recurrent prostate cancer after radiation therapy should consider salvage radical prostatectomy as it offers superior biochemical disease-free survival and may potentially offer the best chance of cure.

Cited by 115 publications

References 16 publications

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

Emerging Treatments for Recurrent Prostate Cancer

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

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