title: Single-institution comparative study on the outcomes of salvage cryotherapy versus salvage robotic prostatectomy for radio-resistant prostate cancer.
abstract: BACKGROUND
  Although primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments.
  
  
  METHODS
  From January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists. Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment.
  
  
  RESULTS
  Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy.
  
  
  CONCLUSIONS
  While recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity.
authors.affiliation: Chesapeake Urology Associates, Silver Spring, MD, USA.
authors.forename: Anup
authors.initials: A
authors.lastname: Vora
authors.affiliation: Cleveland Clinic Florida, Department of Urology, Weston, FL, USA.
authors.forename: Vidhi
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Cleveland Clinic Florida, Department of Urology, Weston, FL, USA.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.affiliation: Eastern Carolina University, Greenville, NC, USA.
authors.forename: Rupen
authors.initials: R
authors.lastname: Patel
authors.affiliation: Cleveland Clinic Florida, Department of Urology, Weston, FL, USA.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Rivas
authors.affiliation: Cleveland Clinic Florida, Department of Urology, Weston, FL, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Nething
authors.affiliation: Cleveland Clinic Florida, Department of Urology, Weston, FL, USA.
authors.forename: Nic
authors.initials: N
authors.lastname: Muruve
keywords: Cryotherapy; Prostate cancer; Radioresistant; Robotic prostatectomy; Salvage