Long-Term Oncologic Outcomes of Salvage Cryoablation for Radio-Recurrent Prostate Cancer

Abstract

A single center, long-term experience documented by a prospectively maintained database shows that cryoablation is a viable salvage option for radio-recurrent prostate cancer as it provides durable biochemical disease-free survival with acceptable morbidity.

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

“…[27] reported a 5‐year BRFS of 21% applying a PSA nadir of >0.4 ng/mL or every increase of PSA after PSA nadir as the definition of BR. However, using the Phoenix definition 5‐year BRFS rates vary from 45% to 64%, similar to our present data (BRFS of 52%), and resembling BRFS rates reported after salvage prostatectomy [14,20,22,27].…”

“…In our present study, the PSA level at initial diagnosis, type of initial treatment, age, interval between initial treatment and SCS, and post‐SCS PSA nadir were significant predictive factors for BRFS. We also confirmed that patients with a pre‐SCS PSA level of >10 ng/mL have worse outcomes than those with a PSA level of <10 ng/mL [14,19,20]. This finding emphasises the importance of early recognition of patients with rrPCa.…”

“…[19] developed a pretreatment nomogram for SCS patient selection, based on PSA, Gleason Score and clinical stage at initial diagnosis, predicting BR from a multi‐institutional analysis of 797 patients. Other studies also showed the importance of various parameters at initial diagnosis and pre‐SCS to predict BRFS [14,20]. In our present study, the PSA level at initial diagnosis, type of initial treatment, age, interval between initial treatment and SCS, and post‐SCS PSA nadir were significant predictive factors for BRFS.…”

“…[22] showed that patients treated with pre‐SCS ADT had inferior 5‐year BRFS rates (Phoenix definition) compared to ADT‐naïve patients (64% vs 39%, P < 0.001), as was also observed in our present study. Although post‐SCS PSA nadir appeared to be a strong BRFS predictor, as also found in other studies, this parameter cannot be used for patient selection but might be helpful during follow‐up in order to intensify monitoring and/or to start ADT [20,23].…”

“…However, as mechanisms of cell death following RT vs cryosurgery differ, strictly this definition might be insufficiently valid to apply for cryosurgery. Either a PSA level of <0.5 ng/mL or <1.0 ng/mL are possibly better parameters to define BRFS following cryosurgery, as different studies suggest these cut‐offs as the best objective predictors for biochemical control [20,23,26]. Therefore, we decided to analyse and report PSA level of >0.5 ng/mL as a secondary outcome.…”