Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy

Abstract

Objectives• To present the oncological and functional outcomes of salvage focal (SFC) and salvage total (STC) cryoablation for recurrent prostate cancer (PCa) after failed primary radiotherapy. Patients and Methods• From March 2003 to August 2010, 50 men with biopsy-proven unilateral (n = 25) or bilateral (n = 25) radio-recurrent PCa underwent SFC or STC, respectively. • Patients were assessed after treatment by prostate-specific antigen (PSA) testing, transrectal ultrasonography, biopsy and questionnaires. Biochemical failure (BF) was defined using the Phoenix criteria (PSA nadir + 2 mg/mL).• Data were prospectively collected and retrospectively analysed. Results• The median pre-cryoablation PSA level and Gleason score were, respectively, 2.8 ng/mL and 7 for SFC, and 3.9 ng/mL and 7 for STC. The median follow-up was 31 and 53 months (P = 0.004) for SFC and STC, respectively.• Oncological outcomes were as follows: no patient died; one patient who underwent STC developed bone metastases; eight patients who underwent SFC and three who underwent STC had BF and the 5-year BF-free survival rates were 54 and 86%, respectively. In those patients without BF, the mean PSA decreased by 86% for SFC and 90% for STC within the first year and remained stable.• Functional outcomes were as follows: new onset urinary incontinence occurred in three (13%) patients in the STC group, whereas no patient in the SFC group developed incontinence (P = 0.10); Two of seven patients in the SFC group retained postoperative potency, but none of the four potent patients in the STC group recovered potency postoperatively (P = 0.48); one (4%) patient in the STC group developed a recto-urethral fistula, but none occurred in the SFC group (P = 0.48). Conclusions• SFC and STC are feasible and safe with acceptable mid-term oncological outcomes. For carefully selected patients, SFC is an option that could be associated with lower treatment-related morbidity compared with STC.• Although longer follow-up and more patient numbers are needed, our initial oncological and functional outcomes of SFC and STC are encouraging.

Cryosurgery would be An Effective Option for Clinically Localized Prostate Cancer: A Meta-analysis and Systematic Review

“…Twenty-eight publications20212223242526272829303132333435363738394041424344454647, which had reported availably single-arm results of CS treatment for clinically localized PCa, were screened. Sixteen23242526293031333436384142454647 of these papers had presented outcomes for primary therapy, eight2022272832354043 for salvage therapy following RT, one44 for salvage therapy following primary CS, and three213739 for both therapies.…”

“…Sixteen23242526293031333436384142454647 of these papers had presented outcomes for primary therapy, eight2022272832354043 for salvage therapy following RT, one44 for salvage therapy following primary CS, and three213739 for both therapies. In addition, materials from the Cryo On-Line Data Registry were used in four publications30404546.…”

“…Eighteen studies212224252829323435363738404142434647 showed the outcomes of OS, which revealed a pooled OS of 73–100% at all stages of follow-up (95.9% at year 1, 94.3 at year 3, 73–98.9% OS at year 5, 91–92% at year 8 and 87% at year 10). Fifteen publications212224252729343536373841424347 presented results of 79–100% DSS.…”

“…Fifteen publications212224252729343536373841424347 presented results of 79–100% DSS. Differences between primary and salvage treatment were not clear.…”

Diagnosis and management of local recurrence after low-dose-rate brachytherapy

“…(37) treated 25 radiation failures with salvage focal cryoablation and noted 5-year biochemical disease-free failure (bDFS) of 54%. No patients had incontinence or fistula.…”