Salvage cryoablation of the whole prostate gland can provide disease control in men with localized prostate cancer recurrence after radiation therapy, a new study finds.
In the study of 110 patients treated with salvage whole-gland cryoablation from 2002 to 2019, investigators determined that 91.8% had cT1, 7.3% had cT2, and 0.9% had cT3 at post-radiation biopsy. Bone scans, conventional computed tomography, and/or PET/CT indicated no metastasis. The median follow-up for patients without biochemical recurrence after the procedure was 71 months.
Biochemical recurrence-free survival was 85%, 81%, 79%, 75%, 71%, and 67% at 12, 24, 36, 48, 60, and 72 months, respectively, Thomas J. Polascik, MD, of Duke Cancer Institute, Duke University Medical Center in Durham, North Carolina, and colleagues reported in European Urology Oncology. Patients without PSA elevation at 6 years appeared cured.
Men with fewer positive cores at post-radiation biopsy and lower PSA tended to have better oncologic outcomes. A higher PSA nadir after salvage whole-gland cryoablation was strongly associated with worse biochemical recurrence-free survival. The risk for biochemical recurrence significantly increased 3.2-, 14.0-, and 582.5-fold at a PSA nadir of 0.02-0.50, 0.51-1.99, and 2.0 ng/mL or more, respectively, compared with a nadir of 0.01 ng/mL or less.
The metastasis-free survival rates at 24 and 60 months were 97% and 90%, respectively. The cancer-specific survival rates at 24 and 60 months were 100% and 98.8%, respectively.
The median International Index of Erectile Function-5 (IIEF-5) score was 5 before cryoablation and 1 after the procedure. Stress urinary incontinence, defined as the use of any pads after treatment, was 5% at 3 months and 9% at 12 months. Complications occurred in 11 patients (11.8%). Clavien-Dindo grade 3 or higher adverse events occurred in 3 patients (2.7%).
In patients with localized radiation-recurrent prostate cancer, salvage whole-gland cryoablation achieved “excellent oncological outcomes with a low rate of urinary incontinence, and represents an alternative to salvage radical prostatectomy,” Dr Polascik’s team wrote. The investigators noted that modern cryotherapy probes can be placed via a transperineal approach using a brachytherapy grid template to deliver a more controlled freeze length and use argon gas for rapid freezing and thawing.
Phin Tan W, Kotamarti S, Ayala A, et al. Oncological and functional outcomes for men undergoing salvage whole-gland cryoablation for radiation-resistant prostate cancer. Eur Urol Oncol. Published online March 6, 2023. doi:10.1016/j.euo.2023.02.007