title: Long-Term Oncologic Outcomes of Salvage Cryoablation for Radio-Recurrent Prostate Cancer.
abstract: OBJECTIVE
  Management of localized radio-recurrent prostate cancer is not standardized, partly due to the absence of long-term data on oncologic control and the toxicity of various treatment modalities. We analyzed the long-term oncologic outcomes and morbidity of salvage cryoablation for radio-recurrent prostate cancer.
  
  
  METHODS
  Patients undergoing salvage cryoablation for biopsy proven, localized radio-recurrent prostate cancer from 1995 to 2004 were prospectively accrued. Preoperative characteristics, perioperative morbidity and postoperative data were reviewed from a prospectively maintained database or via telephonic contact with the patient. The primary outcome was overall survival. Secondary outcomes were metastasis-free and biochemical disease-free survival. The Kaplan-Meier method was used for survival analysis and multivariable Cox regression analysis was performed.
  
  
  RESULTS
  Of 187 patients 157 (84%) had records available for followup. Mean ± SD age was 69.4 ± 5.8 years and mean presalvage prostate specific antigen was 6.6 ± 5.7 ng/ml. Median followup was 117 months (IQR 55-154). Five and 10-year overall survival was 93% and 76%, respectively. Biochemical disease-free survival at 10 and 15 years was 35% and 22.6% whereas metastasis-free survival at 10 and 15 years was 86% and 71%, respectively. On multivariable analysis precryoablation and nadir prostate specific antigen values were significant predictors of metastasis-free and biochemical disease-free survival. Age at salvage cryoablation (p = 0.008) and nadir prostate specific antigen (p = 0.015) were significant predictors of overall survival. There were 157 Clavien-Dindo grade 1-2 and 22 grade 3 complications.
  
  
  CONCLUSIONS
  A single center, long-term experience documented by a prospectively maintained database shows that cryoablation is a viable salvage option for radio-recurrent prostate cancer as it provides durable biochemical disease-free survival with acceptable morbidity.
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Khurram M
authors.initials: KM
authors.lastname: Siddiqui
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Michele
authors.initials: M
authors.lastname: Billia
authors.affiliation: University of Dammam, Dammam, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Zahrani
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Goodman
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Arifin
authors.affiliation: Woodstock Hospital, Woodstock, Ontario, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Violette
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Glenn
authors.initials: G
authors.lastname: Bauman
authors.affiliation: Western University, London, Ontario, Canada. Electronic address: Joseph.Chin@LHSC.ON.CA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: cryosurgery; neoplasm recurrence, local; prostatic neoplasms; radiotherapy; salvage therapy