Salvage cryotherapy with third-generation technology for locally recurrent prostate cancer after radiation therapy.
OBJECTIVE
To present the intermediate results of the use of third-generation cryotherapy as salvage treatment for locally recurrent prostate cancer after radiation therapy.


METHODS
From January 2006 to July 2010, 32 patients with locally recurrent prostate cancer after radiotherapy underwent salvage cryoablation using third-generation technology. Biochemical recurrence-free survival (BRFS) was defined as the time period from salvage treatment to the date of biochemical recurrence (Phoenix definition of nadir +2 ng/ml). Complications were classified as grades 1-5 according to the modified Clavien system. Multivariate logistic regression analysis was performed to identify potential risk factors associated with recurrence after salvage cryotherapy.


RESULTS
The median follow-up was 63 months (range 38-92). Mild complications (grades 1 and 2) included mild incontinence (9.4 %), acute rectal pain (31.3 %), hematuria (6.3 %), scrotal edema (9.4 %), urinary tract infection (3.1 %), lower urinary tract symptoms (15.6 %) and erectile dysfunction (57.1 %). Severe events (grade 3) included severe incontinence (3.1 %) and urethral sloughing (3.1 %). The rate of rectourethral fistula and urinary retention was absent. The 5-year overall survival was 92.3 %. The 5-year cancer-specific survival was 100 %. The 5-year BRFS rate using the Phoenix definition was 43.5 %. A multivariate analysis disclosed that PSA at cryoablation was the only predictive factor for biochemical recurrence.


CONCLUSIONS
Salvage cryotherapy using third-generation technology offers a safe and effective alternative for locally recurrent prostate cancer after radiation therapy. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.
Department of Urology, Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
Huibo
H
Lian
Department of Urology, Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
Rong
R
Yang
Department of Urology, Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
Tingsheng
T
Lin
Department of Urology, Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
Wei
W
Wang
Department of Urology, Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
Gutian
G
Zhang
Department of Urology, Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China. doctorghq@gmail.com.
Hongqian
H
Guo
D000368:Aged; D003452:Cryosurgery / Q000009:adverse effects; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy / Q000601:surgery*; D016879:Salvage Therapy / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen
Cryotherapy; Prostate cancer; Radiation therapy; Recurrence