Of patients undergoing radiotherapy (RT) for prostate cancer (PC), at least 15-20% will experience recurrence. Although salvage prostatectomy achieves durable oncological outcomes at 10 years, it is associated with significantly high morbidity. Thus, the majority of men with radio-recurrent prostate cancer (rrPC) are placed on non-curative androgen deprivation therapy. In this original article the authors assessed the long-term oncological outcomes and the associated morbidity of cryoablation performed between 1995-2004 for biopsy proven localised rrPC. The primary outcome was overall survival (OS) and secondary outcomes were metastasis-free survival (MFS) and biochemical disease-free survival (BDFS). A total of 197 procedures were performed. Ten underwent repeat procedures for recurrent / persistent disease while 154 had records available for follow-up. Mean pre-cryoablation prostate specific antigen (PSA) was 6.6 +/- 5.7ng/ml. Median follow-up was 117 months and in addition to PSA, patients also underwent prostate biopsies at 6, 12 and 24 months of follow-up, and then if clinically indicated. Biochemical recurrence was defined as per phoenix criteria (nadir PSA + 2). The OS at 5 and 10 years was 93% and 76%, respectively. BDFS at 10 and 15 years was 35% and 22.6% respectively, whereas MFS at 10 and 15 years was 86% and 74%, respectively. The authors found that pre-cryoablation PSA >5 and Gleason sum 8 or greater and post-cryoablation nadir PSA >1 were significant predictors of MFS and BDFS. Age and nadir PSA >1 at the time of salvage cryoablation were significant predictors of OS. Incidence of Clavien-Dindo grade one to two complications – mild incontinence, perineal pain, haematuria, urinary tract infection (UTI), acute urinary retention (AUR) – was common (154) while grade three – bladder neck contracture, severe incontinence, recturethral fistula (RUF) – was experienced in 22 cases. There were no grade four or five complications. RUF occurred in four cases and was successfully repaired in all. Cryoablation was found to be a viable treatment option with durable long-term oncological outcomes and acceptable morbidity.

Long-term oncologic outcomes of salvage cryoablation for radio-recurrent prostate cancer.
Siddiqui KM, Billia M, Al-Zahrani A, et al.
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Zeeshan Aslam

Ninewells Hospital, Dundee, UK; Surgical Tutor, RCPS Glasgow.

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