Salvage Prostate Cryoablation for the Management of Local Recurrence After Primary Cryotherapy: A Retrospective Analysis of Functional and Intermediate-Term Oncological Outcomes Associated With a Second Therapeutic Freeze.

Clin Genitourin Cancer 2019 08 28;17(4):e831-e836. Epub 2019 May 28.

Division of Urologic Surgery, Duke Cancer Institute, Duke University Hospital, Durham, NC- 2 Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The purpose of the study was to examine the outcomes of salvage prostate cryoablation for managing patients with local recurrence after primary cryotherapy.

Patients And Methods: The records of 108 patients treated with salvage prostate cryoablation for biopsy-proven local recurrence after primary cryotherapy were retrospectively reviewed. Oncological outcome was defined by the rate of biochemical recurrence (BCR) after salvage ablation using Phoenix criteria.

Results: Whole-gland (n = 91; 84.3%) or focal (n = 17; 15.7%) salvage cryoablation after failed primary cryosurgery were used. Fifty-eight of 108 patients (53.7%) had received androgen deprivation therapy (n = 35; 32.4%)/radiotherapy (n = 23; 21.3%) before salvage ablation. Two-year and 5-year BCR rates after salvage therapy were 28.2% and 48.3%, respectively. In univariate analysis, a higher Gleason score, D'Amico risk category (P < .0001) as well as prostate-specific antigen density >0.15 ng/mL/cc (P = .02) before second cryotherapy were significantly associated with the risk of BCR. In multivariable analysis, the only significant factor associated with risk of BCR after the second ablation was a higher presalvage D'Amico risk category (P = .008). Persistent urinary incontinence (1-4 pads per day) in 8 (7.4%), temporary urinary retention in 4 (3.7%), and rectourethral fistula in 4 (3.7%) patients were reported 1 year after second cryoablation. During the same period, 13.8% of patients were able to have either spontaneous or medication-augmented erections sufficient for intercourse.

Conclusion: This series, to our knowledge, represents the largest cohort of patients who received 2 cryoablation treatments. Local failure after primary cryoablation can be salvaged by second cryosurgery with acceptable intermediate-term disease control. Patients should be counseled regarding the side effect profile associated with second cryoablation.

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http://dx.doi.org/10.1016/j.clgc.2019.05.014DOI Listing
August 2019

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