Salvage cryotherapy is a valid alternative to hormonal treatment and surgery for local disease recurrence after radiotherapy for prostate cancer (PCa), according to a new study.
Researchers led by Göran Ahlgren, MD, PhD, of Skåne University Hospital, Malmö, Sweden, studied 30 patients who received 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.