title: Treatment of prostate cancer local recurrence after radical retropubic prostatectomy with 17-gauge interstitial transperineal cryoablation: initial experience.
abstract: OBJECTIVE
  Interstitial transperineal cryoablation with 17-gauge cryoprobes is an accepted treatment modality for localized prostate cancer. The effectiveness of cryoablation in the treatment of local prostate cancer recurrence after radical retropubic prostatectomy (RRP) is unknown.
  
  
  METHODS
  We reviewed the outcome of cryoablative treatment in 15 patients for biopsy-proven locally recurrent prostate cancer after RRP. The follow-up data included prostate-specific antigen (PSA) level, imaging findings, side effects, and an assessment of voiding habits.
  
  
  RESULTS
  The mean follow-up time for the entire group was 20 months (range 4 to 32). Of the 15 patients, 6 (40%) had sustained declines in the PSA level (cryoablation success group) and 9 (60%) had disease progression (cryoablation failure group), defined as a PSA increase greater than 0.1 ng/mL from the PSA nadir, or the addition of external beam radiotherapy or androgen deprivation therapy. The pre-RRP PSA level and pre-cryoablation PSA level were similar for both groups. The pre-RRP biopsy Gleason scores (P = 0.03), RRP Gleason scores (P = 0.03), and lesion size on magnetic resonance imaging (P = 0.001) were lower in the success group than in the failure group. All patients who were recurrence free after cryotherapy had a biopsy and Gleason score of 6 or less. Of the 15 patients, 3 (20%) developed worsening of post-RRP incontinence.
  
  
  CONCLUSIONS
  Our preliminary results suggest that salvage cryoablation can be an effective and safe treatment modality and a possible alternative to external beam radiotherapy for targeted control of confirmed local recurrences after RRP, especially in those with favorable biopsy or pathologic Gleason scores before cryotherapy. Larger cohorts and longer follow-up are needed to assess the viability of this treatment.
authors.affiliation: Department of Urology, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Siddiqui
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
authors.forename: Horst
authors.initials: H
authors.lastname: Zincke
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Hoffmann
authors.forename: John R
authors.initials: JR
authors.lastname: Lobo
authors.forename: Torrence M
authors.initials: TM
authors.lastname: Wilson
authors.forename: Akira
authors.initials: A
authors.lastname: Kawashima
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
mesh_terms: D000368:Aged; D003452:Cryosurgery / Q000295:instrumentation; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*