title: Only carefully selected patients may have a beneficial effect of salvage cryoablation in recurrent prostate cancer after radiotherapy.
abstract: BACKGROUND
  In Denmark, salvage cryoablation of locally recurrent prostate cancer (sCAP) after curatively intended radiation therapy (RT) is the only potentially curable option, and this experimental treatment has only been offered at Aarhus University Hospital. This study presents our experiences with the treatment.
  
  
  METHODS
  sCAP procedures were performed from 2006 to 2012. Cases were registered prospectively. Recurrent disease was defined by the Phoenix criterion (prostate-specific antigen (PSA) level > PSA nadir + 2 ng/ml).
  
  
  RESULTS
  A total of 39 sCAP treatments were performed in 37 patients. Four patients had previously been treated with brachytherapy and 33 with external radiation. There were two cases of hemiablations; the remaining cases were total ablations. The median follow-up period was 42 (0-69) months and the age at the time of treatment was 66 (53-78) years. Stratified according to D'Amico et al's 2003 risk definition, five patients had pre-RT intermediate-risk disease, and 31 had high-risk disease. Three cases could not be classified. Biochemical recurrence was found in 27 cases, and the 12-month disease-free survival was 18.2% overall. No patient in the intermediate group had recurrence. In high-risk patients, there were 25 cases of recurrence and the 12-month disease-free survival was 10.7%. There were five (13%) cases of fistula formation and seven (19%) cases of severe post-operative incontinence, all in previous high-risk patients. Information on potency was deficient.
  
  
  CONCLUSIONS
  In this limited study, sCAP was very infrequently a curable treatment in high-risk patients, and the treatment carried a high risk of severe morbidity. It seems, however, that sCAP could be beneficial to patients, primarily in the intermediate-risk group.
  
  
  BACKGROUND
  The Central Denmark Region's Health Research Foundation and the Danish Cancer Society financed the salary of the primary investigator.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Urinvejskirurgisk Afdeling, Aarhus Universitetshospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark. dr.elkjaer@gmail.com.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Elkjær
authors.forename: Michael
authors.initials: M
authors.lastname: Borre
mesh_terms: D000368:Aged; D003452:Cryosurgery / Q000009:adverse effects; D003718:Denmark; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000145:classification / Q000601:surgery*; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy / Q000601:surgery*; D012003:Rectal Fistula / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000009:adverse effects; D014522:Urethral Diseases / Q000209:etiology*; D014548:Urinary Fistula / Q000209:etiology*; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen