title: Disease-free survival following salvage cryotherapy for biopsy-proven radio-recurrent prostate cancer.
abstract: BACKGROUND
  The optimum treatment of prostate cancer recurrence following radiation therapy (RT) remains controversial due to the lack of long-term data.
  
  
  OBJECTIVE
  Our aim was to review the survival of patients who underwent salvage cryotherapy to the prostate gland for biopsy-proven recurrent prostate cancer and establish prognostic indicators.
  
  
  METHODS
  A retrospective analysis was performed on all patients undergoing salvage cryotherapy at an academic urology unit for biopsy-proven locally recurrent prostate cancer after RT from 1995 to 2004. Patients' preoperative, perioperative, and postoperative data were reviewed and recorded.
  
  
  METHODS
  Two freeze-thaw cycles of transperineal cryotherapy were performed under transrectal ultrasound guidance by a single surgeon.
  
  
  METHODS
  The primary outcome was survival. Secondary outcomes were disease-free survival (DFS), metastasis-free survival, and progression to androgen-deprivation therapy.
  
  
  CONCLUSIONS
  Of 187 patients, 176 had records available for follow-up (follow-up rate: 94%). Mean follow-up was 7.46 yr (range: 1-14 yr). Fifty-two patients were followed for >10 yr. DFS at 10 yr was 39%. Risk factors for recurrence were presalvage prostate-specific antigen (PSA), preradiation, and presalvage Gleason score. A PSA nadir >1.0 ng/dl was highly predictive of early recurrence.
  
  
  CONCLUSIONS
  Salvage cryotherapy led to an acceptable 10-yr DFS. Presalvage PSA and Gleason score were the best predictors of disease recurrence. A PSA nadir >1 ng/dl following cryotherapy indicated a poor prognosis, and recurrence of disease was universal in these patients.
authors.affiliation: Department of Urology and Oncology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Williams
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Martínez
authors.forename: Chen
authors.initials: C
authors.lastname: Lu
authors.forename: Chee Kwan
authors.initials: CK
authors.lastname: Ng
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D001706:Biopsy; D001918:Brachytherapy; D016009:Chi-Square Distribution; D017679:Cryotherapy; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009864:Ontario; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen