Salvage Prostate Cryoablation Promising

Study suggests salvage focal cryoablation can be an effective treatment with encouraging potency preservation.
Study suggests salvage focal cryoablation can be an effective treatment with encouraging potency preservation.

Salvage prostate cryoablation as a focal or whole-gland therapy may be an effective treatment for patients with recurrent prostate cancer (PCa) following radiotherapy, according to the findings to 2 new studies.

In a study of 91 men who underwent salvage focal cryoablation for biopsy-proven recurrent PCa after radiotherapy, J. Stephen Jones, MD, of Cleveland Clinic, and colleagues found that the patients had biochemical disease-free survival rates of 95.3%, 72.4%, and 46.5% at 1, 3, and 5 years, respectively. In addition, 4 (28.6%) of 14 patients who underwent prostate biopsies had positive biopsies after salvage treatment, Dr. Jones' group reported in The Prostate (2015;75:1–7). 

The researchers observed rectourethral fistula in 3 cases (3.3%), urinary retention in 6 cases (6.6%), and urinary incontinence requiring pad use in 5 cases (5.5%). Of 20 patients who reported potency prior to salvage treatment, 10 (50%) reported successful intercourse afterward.

“The outcomes from this observational study indicate that salvage focal cryoablation can be an effective treatment with encouraging potency preservation for patients with locally recurrent PCa after radiotherapy,” the investigators concluded. “However, other morbidity including rectourethral fistula and incontinence are not clearly lower than for patients treated with salvage whole gland cryoablation.”

The researchers observed that studies with longer follow-up times, more patients, and direct comparisons with salvage whole-gland cryoablation are needed before recommending salvage focal cryoablation as a standard treatment option for these patients.

For the study, the researchers used data from the Cryo On-Line Data Registry. “To our knowledge, this is the largest data set assembled for salvage focal cryoablation for the treatment of localized PCa recurrence after radiotherapy.”

The other study, by Göran Ahlgren, MD, PhD, of Skåne University Hospital, Malmö, Sweden, included 30 men who received whole-gland transperineal cryotherapy at the hospital for biopsy-verified local PCa recurrence after radiotherapy. The patients had a median age of 70 years (range 61–80 years). The median follow-up after cryotherapy was 2.7 years (maximum 6.6 years). The median time from primary radiotherapy to cryotherapy was 7 years.

Of 23 patients without hormonal treatment at the time of cryotherapy, 11 achieved a PSA nadir of less than 0.5 ng/mL, Dr. Ahlgren's group reported online ahead of print in the Scandinavian Journal of Urology. At the end of follow-up, 5 of these 23 patients still had a PSA level below 0.5 ng/mL and 10 were free from recurrence according to the Phoenix definition (PSA nadir plus 2 ng/mL). The investigators detected clinical recurrence—verified with imaging or biopsies—in 13 patients, of whom 6 had local recurrence. Death from PCa occurred in 1 patient.

With respect to complications, urinary incontinence grade 1–2 and 3–4 occurred in 11 and 3 patients, respectively. Severe but transitory tissue sloughing occurred in 3 patients. In addition, 3 patients experienced a urethral stricture or had prolonged urinary retention, and 1 patient developed a urinary fistula 4.5 years after cryotherapy.

“The results from Skåne University Hospital in Malmö compare well with those reported from centres with longer experience,” the authors wrote. “Proper patient selection is crucial for obtaining optimal results.”

The researchers acknowledged that their study is limited by the small number of treated patients and lack of prospective, patient-reported evaluation of side effects.

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