title: Locally recurrent prostate cancer after initial radiation therapy: a comparison of salvage radical prostatectomy versus cryotherapy.
abstract: OBJECTIVE
  We compared the treatment outcomes of salvage radical prostatectomy and salvage cryotherapy for patients with locally recurrent prostate cancer after initial radiation therapy.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients who underwent salvage radical prostatectomy at the Mayo Clinic between 1990 and 1999, and those who underwent salvage cryotherapy at M. D. Anderson Cancer Center between 1992 and 1995. Eligibility criteria were prostate specific antigen less than 10 ng/ml, post-radiation therapy biopsy showing Gleason score 8 or less and prior radiation therapy alone without pre-salvage or post-salvage hormonal therapy. We assessed the rates of biochemical disease-free survival, disease specific survival and overall survival in each group. Biochemical failure was assessed using the 2 definitions of 1) prostate specific antigen greater than 0.4 ng/ml and 2) 2 increases above the nadir prostate specific antigen.
  
  
  RESULTS
  Mean followup was 7.8 years for the salvage radical prostatectomy group and 5.5 years for the salvage cryotherapy group. Compared to salvage cryotherapy, salvage radical prostatectomy resulted in superior biochemical disease-free survival by both definitions of biochemical failure (prostate specific antigen greater than 0.4 ng/ml, salvage cryotherapy 21% vs salvage radical prostatectomy 61% at 5 years, p <0.001; 2 increases above nadir with salvage cryotherapy 42% vs salvage radical prostatectomy 66% at 5 years, p = 0.002) and in superior overall survival (at 5 years salvage cryotherapy 85% vs salvage radical prostatectomy 95%, p = 0.001). There was no significant difference in disease specific survival (at 5 years salvage cryotherapy 96% vs salvage radical prostatectomy 98%, p = 0.283). After adjusting for post-radiation therapy biopsy Gleason sum and pre-salvage treatment serum prostate specific antigen on multivariate analysis salvage radical prostatectomy remained superior to salvage cryotherapy for the end points of any increase in prostate specific antigen greater than 0.4 ng/ml (HR 0.24, p <0.0001), 2 increases in prostate specific antigen (HR 0.47, p = 0.02) and overall survival (HR 0.21, p = 0.01).
  
  
  CONCLUSIONS
  Young, healthy patients with recurrent prostate cancer after radiation therapy should consider salvage radical prostatectomy as it offers superior biochemical disease-free survival and may potentially offer the best chance of cure.
authors.affiliation: Department of Urology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA. Lpisters@mdanderson.org
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.forename: Dan
authors.initials: D
authors.lastname: Leibovici
authors.forename: Michael
authors.initials: M
authors.lastname: Blute
authors.forename: Horst
authors.initials: H
authors.lastname: Zincke
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sebo
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Slezak
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.forename: John F
authors.initials: JF
authors.lastname: Ward
authors.forename: Shellie M
authors.initials: SM
authors.lastname: Scott
authors.forename: Lydia
authors.initials: L
authors.lastname: Madsen
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017679:Cryotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy