title: Magnetic resonance imaging-guided cryoablation of recurrent prostate cancer after radical prostatectomy: initial single institution experience.
abstract: OBJECTIVE
  To establish the feasibility of magnetic resonance imaging (MRI)-guided cryoablation in patients with previous radical prostatectomy and MRI visualized biopsy-proven local recurrence of prostate adenocarcinoma.
  
  
  METHODS
  Eighteen postprostatectomy patients (mean 67, 57-78 years) were treated with MRI-guided cryoablation for recurrent prostate carcinoma. Patients were found to have a hyperenhancing nodule using multiparametric MRI with endorectal coil followed by a positive transrectal ultrasound-guided biopsy. Of 18 postsurgical patients, 6 had additional salvage external beam radiation with subsequent recurrence. Under general anesthesia and MRI guidance (wide-bore 1.5T MRI), 2-5 cryotherapy probes were placed in or around the recurrence by transperineal approach and cryoablation performed. The patients were stratified into 2 groups: the initial 9 consecutive patients had cryoprobes placed 1 cm apart with 2 freeze-thaw cycles (group 1), and the subsequent 9 patients had cryoprobes placed 0.5 cm apart with 3 freeze-thaw cycles (group 2).
  
  
  RESULTS
  In group I, the average preprocedure prostate-specific antigen (PSA) was 1.21 ± 1.12 ng/mL, and 1-3 months postprocedure PSA was 0.14 ± 0.11 ng/mL (P <.01). Sixty-seven percent of patients had PSA ≤0.2 ng/mL at 1-3 months follow-up, but only 25% at 4-6 months. No change in impotence or incontinence occurred. In group II, average preprocedure PSA was 2.24 ± 2.71 ng/mL, and 1-3 month postprocedure PSA was 0.08 ± 0.10 ng/mL (P <.05). Eighty-nine percent of patients had PSA ≤0.2 ng/mL at 1-3 months follow-up and at 4-6 months. Complications in group 2 included worsening incontinence in 3 patients.
  
  
  CONCLUSIONS
  MRI-guided salvage cryoablation of postradical prostatectomy prostate cancer recurrence is safe and feasible. Both techniques produce early PSA decrease with more lasting PSA results in the more aggressive group II methodology.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: David A
authors.initials: DA
authors.lastname: Woodrum
authors.forename: Akira
authors.initials: A
authors.lastname: Kawashima
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
authors.forename: Donald E
authors.initials: DE
authors.lastname: Engen
authors.forename: Krzysztof R
authors.initials: KR
authors.lastname: Gorny
authors.forename: Joel P
authors.initials: JP
authors.lastname: Felmlee
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Callstrom
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D003452:Cryosurgery / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen