title: Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer.
abstract: BACKGROUND
  We compared the morbidity of whole gland salvage ablation using cryotherapy (CRYO) and high-intensity focused ultrasound (HIFU) for radio recurrent prostate cancer at a single centre over a 17-year period.
  
  
  METHODS
  Patients were divided in 3 cohorts. Group 1 included the first 65 patients treated with CRYO (1995-1998); Group 2 included the last 65 patients treated with CRYO (2002-2004), and Group 3 included 65 patients treated with HIFU (2006-2011). We analyzed the complications reported within at least 90 days of treatment or up to the last follow-up.
  
  
  RESULTS
  We tallied Clavien grade complications. For Groups 1, 2 and 3, we recorded the following Clavien I-II complications: 78, 49 and 13, respectively. For Clavien grade IIIa, 2, 5 and 4 for Groups 1, 2 and 3, respectively. For Clavien grade IIIb, 8, 2 and 3 for Groups 1, 2 and 3, respectively. Clavien grade II complications were statistically higher in Group 1 versus Group 2 (p = 0.005) and in Group 2 versus Group 3 (p = 0.0001). The rate of mild-moderate incontinence was significantly higher in the CRYO group compared to the HIFU cohort (p ≤ 0.05). The rate of urinary retention was significantly higher in Group 2 compared to Group 3 (p = 0.0005). The rates of severe incontinence (range: 1.5%-5%), need for surgical intervention (uniform at 1.5%), and recto-urethral fistulae (range: 1.5%-3%) were not statistically different.
  
  
  CONCLUSIONS
  CRYO was associated with higher overall morbidity. The morbidity during the early experience with HIFU was lower than both subgroups of CRYO. This may reflect the advancement of technology or cumulative learning experience.
authors.affiliation: Western University, London, ON;
authors.forename: Khurram M
authors.initials: KM
authors.lastname: Siddiqui
authors.affiliation: Western University, London, ON;
authors.forename: Michele
authors.initials: M
authors.lastname: Billia
authors.affiliation: Western University, London, ON;
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
authors.affiliation: Department of Urology, University of Dammam, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Alzahrani
authors.affiliation: Western University, London, ON;
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin