title: Salvage cryotherapy for local recurrence after radiotherapy for prostate cancer.
abstract: OBJECTIVE
  The aim of this study was to present the outcome of patients treated with salvage cryotherapy after radiotherapy for prostate cancer at one institution.
  
  
  METHODS
  Consecutive patients treated between 2007 and 2013 with transperineal cryotherapy for biopsy-verified local recurrence after radiotherapy were investigated. An external reviewer retrieved outcome data retrospectively from medical records. Complications were graded according to the Clavien classification. One patient with less than 1 year of follow-up was excluded from the analysis of side-effects.
  
  
  RESULTS
  Thirty patients were included, 29 of whom had a follow-up of at least 1 year. The median follow-up was 2.7 years (range 1-6.5 years). Eleven of the 23 patients without hormonal treatment at the time of cryotherapy reached a prostate-specific antigen (PSA) nadir of less than 0.5 ng/ml. At the end of follow-up five of these 23 patients still had a PSA below 0.5 ng/ml and 10 were free from recurrence according to the Phoenix definition. Clinical recurrence (verified with imaging or biopsies) was detected in 13 patients, six of which were local. One patient died from prostate cancer. Eleven patients had urinary incontinence grade 1-2 and three had grade 3-4, seven had pelvic pain, three had severe but transitory tissue sloughing, three developed a urethral stricture or had prolonged urinary retention, and one developed a urinary fistula 4.5 years after cryotherapy.
  
  
  CONCLUSIONS
  Salvage cryotherapy should be considered as an alternative to hormonal treatment and surgery for local recurrence after radiotherapy for prostate cancer. The results compare well to those reported from centres with longer experience.
authors.affiliation: Medical School, Faculty of Health and Medical Science, University of Copenhagen , Denmark.
authors.forename: Klara
authors.initials: K
authors.lastname: Kvorning Ternov
authors.forename: Ane
authors.initials: A
authors.lastname: Krag Jakobsen
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
authors.forename: Göran
authors.initials: G
authors.lastname: Ahlgren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000009:adverse effects* / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000628:therapy*; D017699:Pelvic Pain / Q000453:epidemiology; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D011878:Radiotherapy; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen
keywords: Cryotherapy; prostate cancer; salvage