title: Salvage focal prostate cryoablation for locally recurrent prostate cancer after radiotherapy: initial results from the cryo on-line data registry.
abstract: BACKGROUND
  Several investigators have tried to apply salvage focal prostate cryoablation to small numbers of patients with biopsy-proven unilateral recurrent prostate cancer (PCa) after radiotherapy with the aim of decreasing complications of salvage cryoablation. We report contemporary outcomes of salvage focal cryoablation for locally recurrent PCa after radiotherapy within the Cryo On-Line Data (COLD) Registry.
  
  
  METHODS
  We queried the COLD Registry to identify patients diagnosed as locally recurrent PCa after radiotherapy and treated with salvage focal cryoablation. Patients with hormone ablation after cryotherapy were excluded. The biochemical disease-free survival and morbidities were analyzed. Biochemical failure was defined using the Phoenix definition.
  
  
  RESULTS
  From 2002 to 2012, 91 patients with biopsy-proven radio-recurrent PCa underwent salvage focal cryoablation with curative intent. The biochemical disease-free survival rates were 95.3%, 72.4%, and 46.5% at 1, 3, and 5 years, respectively. Positive biopsies after salvage focal cryoablation were observed in four of 14 patients who underwent biopsy (28.6%). Rectourethral fistula was observed in three cases (3.3%). Urinary retention was observed in six cases (6.6%). Incontinence (requiring pad use) was reported in five cases (5.5%). Intercourse was reported in 10 of 20 patients (50%) who reported potency before salvage focal cryoablation.
  
  
  CONCLUSIONS
  The outcomes from this observational study indicate that salvage focal cryoablation can be an effective treatment with encouraging potency preservation for patients with locally recurrent PCa after radiotherapy. However, other morbidity including rectourethral fistula and incontinence are not clearly lower than for patients treated with salvage whole gland cryoablation. Studies with longer follow-up, more patients, and direct comparison to salvage whole gland cryoablation are needed before recommending salvage focal cryoablation as a standard treatment option for these patients.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Li
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elshafei
authors.forename: Gautum
authors.initials: G
authors.lastname: Agarwal
authors.forename: Herbert
authors.initials: H
authors.lastname: Ruckle
authors.forename: Julio
authors.initials: J
authors.lastname: Powsang
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery*; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012042:Registries; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: cryoablation; focal therapy; prostate cancer; radiotherapy; salvage