title: The efficacy and complications of salvage cryotherapy of the prostate.
abstract: OBJECTIVE
  A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full dose radiation therapy and/or systemic therapy. The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen (PSA) levels and prostate biopsies as end points.
  
  
  METHODS
  A total of 150 patients with locally recurrent prostate cancer following radiation, hormonal therapy and/or systemic chemotherapy underwent salvage cryotherapy using a single (71 men, mean followup 17.3 months) or double (79 men, mean followup 10.0 months) freeze-thaw cycle. PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively. Complications were assessed by retrospective chart review and a mailed quality of life survey.
  
  
  RESULTS
  Overall, 45 patients (31%) had persistently undetectable PSA. Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate (93 versus 71%, p < 0.02) and lower biochemical failure rate (defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value, 44 versus 65%, p < 0.03) than those who underwent a single freeze-thaw cycle. The main complications of salvage cryotherapy were urinary incontinence (73% of the patients), obstructive symptoms (67%), impotence (72%) and severe perineal pain (8%).
  
  
  CONCLUSIONS
  Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies. A double freeze-thaw cycle appears more effective than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes significant morbidity.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Pisters
authors.forename: A C
authors.initials: AC
authors.lastname: von Eschenbach
authors.forename: S M
authors.initials: SM
authors.lastname: Scott
authors.forename: D A
authors.initials: DA
authors.lastname: Swanson
authors.forename: C P
authors.initials: CP
authors.lastname: Dinney
authors.forename: C A
authors.initials: CA
authors.lastname: Pettaway
authors.forename: R J
authors.initials: RJ
authors.lastname: Babaian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D016879:Salvage Therapy
chemical_list: D017430:Prostate-Specific Antigen