Salvage whole gland cryotherapy provides adequate oncologic control of locally recurrent prostate cancer (PCa) following radiation therapy, a new study finds.
In a retrospective study of 268 patients treated with salvage whole gland cryotherapy from 1992 to 2004, disease-specific survival (DSS) was 81% and overall survival (OS) was 77% at 10 years, Louis Pisters, MD, of The University of Texas MD Anderson Cancer Center in Houston, and colleagues reported in The Journal of Urology. Median OS was 15.8 years and median DSS was not reached.
At 10 years, 69% of patients had freedom from androgen deprivation therapy (ADT), and 76% had freedom from castration-resistant PCa (CRPC). Patients who received neoadjuvant ADT had a significant 78% improvement in OS and a significant 59% improvement in DSS but not freedom from castration-resistant disease or adjuvant ADT.
Having a pre-salvage PSA level exceeding 10 ng/mL was significantly associated with a 3-fold increased risk for CRPC and a 2-fold increased risk of initiating ADT.
Of 223 complications during whole gland cryoablation, 168 had a Clavien score of 1 or 2 and 55 had a Clavien score of 3. Severe incontinence developed in 16.4% of patients and bladder neck contracture developed in 10.4%. Rates of erectile dysfunction could not be assessed.
“Overall, our data demonstrate adequate long-term oncologic outcomes for patients with [radiation refractory PCa] undergoing salvage cryotherapy,” Dr Pisters’ team stated.
“We feel that failure rates of salvage cryotherapy may be reduced using contemporary selective imaging, targeted biopsies and biomarker criteria. Further studies utilizing advanced imaging and molecular modalities in the salvage setting may result in better oncological outcomes as exclusion of advanced disease is more precise.”
Chin JL, Lavi A, Metcalfe MJ, et al. Long-term outcomes of whole gland salvage cryotherapy for locally recurrent prostate cancer following radiation therapy: a combined analysis of two centers. J Urol. doi:10.1097/JU.0000000000001831