The pattern of prostate cancer local recurrence after radiation and salvage cryoablation.
OBJECTIVE
We assessed the pattern of local recurrence after salvage cryoablation of the prostate, and the impact of local recurrence on intermediate-term outcome.


METHODS
One hundred twenty-two patients who underwent salvage cryoablation were studied after a mean follow-up of 56 months. Serial prostate biopsy was carried out after cryoablation. The histopathology of prostate biopsies before and after cryoablation were compared. The prognostic value of post-cryoablation biopsy was assessed with the Cox regression method.


RESULTS
23.1% of patients had a positive biopsy for prostate cancer following salvage cryoablation. Most cancer recurrences occurred in the apex (51.5%), base (21.2%) and seminal vesicles (18.2%). The presence of cancer at the base of the prostate was found to be a prognostic factor for eventual biochemical failure. Overall 5-year biochemical disease-free survival (bDFS) was 28%, however patients with cancer at the base of the prostate had a 5-year bDFS of 0%.


CONCLUSIONS
Cancer recurrences occurred in areas where aggressive freezing was avoided as it might result in serious problems (e.g., urethro-rectal fistula and incontinence). Post-cryoablation biopsies and the location of persistent disease are of prognostic value.
From the Division of Urology, Department of Pathology and Department of Radiology, London Health Sciences Centre, University of Western Ontario, London, ON.
Chee Kwan
CK
Ng
Naji J
NJ
Touma
Venu
V
Chalasani
Madeleine
M
Moussa
Donal B
DB
Downey
Joseph L
JL
Chin
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