Patient Selection for Salvage Cryotherapy for Locally Recurrent Prostate Cancer After Radiation Therapy

Abstract

Patients failing initial radiation therapy with a PSA more than 10 ng/mL and Gleason score of the recurrent cancer more than or equal to 9 are unlikely to be successfully salvaged. Patients failing initial hormonal therapy and radiation therapy are less likely to be successfully salvaged than patients failing radiation therapy only.

Detection of Local, Regional, and Distant Recurrence in Patients With PSA Relapse After External-Beam Radiotherapy Using 11C-Choline Positron Emission Tomography

“…Biochemical recurrence (BCR) following radiotherapy has been defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) (1) and recently updated in the ASTRO Phoenix Consensus (2).The time interval between treatment and BCR as well as PSA doubling time are used as indicators for local or distant recurrence (3). Conventional imaging modalities such as CT and MRI are limited in their ability to localize the site of recurrence with high accuracy (4). Transrectal ultrasound and biopsies may identify local recurrences, but these techniques do not give information about the possible presence of locoregional and distant metastases (4).…”

“…Conventional imaging modalities such as CT and MRI are limited in their ability to localize the site of recurrence with high accuracy (4). Transrectal ultrasound and biopsies may identify local recurrences, but these techniques do not give information about the possible presence of locoregional and distant metastases (4). This means that clinical decision making with respect to salvage treatments such as prostatectomy, cryoablation, or high-intensity focused ultrasound (HIFU) is not possible.…”

Cryotherapy

“…In their series, 97% of patients had PSA nadirs of less than 0.5 ng/ml, and at a median 18.6 months of follow-up, 34% remained below this level (68% had PSA < 4 ng/ml; 10 patients had developed metastatic disease). As in the study by Pisters et al, 62 preprocedure PSA of more than 10 ng/ml, Gleason score of 8 or more, and stage T3/4 disease predicted biochemical failure. 33 …”

Role of transrectal ultrasound guided salvage cryosurgery for recurrent prostate carcinoma after radiotherapy

“…Based on other recent studies, a PSA greater than 10 ng/ml, [40][41][42] a high Gleason score before or after radiotherapy, [41][42][43] stage T3/T4 disease, 41 and a higher grade of cancer 44 all predict unfavorable outcomes. In addition to evidence of metastatic disease, patients with a prior history of transurethral resection of the prostate (TURP) should be excluded from salvage cryoablation due to the heightened risk of sloughing and urinary retention.…”