Prostate gland lengths and iceball dimensions predict micturition functional outcome following salvage prostate cryotherapy in men with radiation recurrent prostate cancer

• Published in: PloS one 2013-08, Vol.8 (8), p.e69243-e69243
• Main Authors: Ahmad, Imran, Kalna, Gabriela, Ismail, Mohamed, Birrell, Fiona, Asterling, Sue, McCartney, Elaine, Greene, Damien, Davies, John, Leung, Hing Y
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis; Antigens; Biology; Biomarkers, Tumor - metabolism; Cancer; Cancer therapies; Cancer treatment; Correlation analysis; Cryosurgery; Cryotherapy; Disease-Free Survival; Freeze thaw cycles; Freeze-thawing; Gamma Rays - therapeutic use; Generalized linear models; Health services; Humans; Male; Medical research; Medicine; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Organ Size; Parameter identification; Patients; Physical properties; Prognosis; Prostate; Prostate - metabolism; Prostate - pathology; Prostate - surgery; Prostate cancer; Prostate-Specific Antigen - metabolism; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiation; Radiation (Physics); Radiation therapy; Recurrence (Disease); Retrospective Studies; Salvage; Salvage Therapy - methods; Side effects; Studies; Surgery, Computer-Assisted; Surveys and Questionnaires; Toxicity; Tumors; Ultrasound; Urination; Urination - physiology; Urology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0069243

Tissue cryoablation is a potential curative option for solid malignancies, including radiation recurrent prostate cancer (RRPC). Case series of salvage cryotherapy (SCT) in RRPC have reported promising disease free survival (DFS) outcomes and acceptable toxicity profile. While many men receive SCT, no predictive factors for treatment induced side effects are known. The aim of this study is to validate the oncologic outcome of SCT in a large multi-centre patient cohort and to identify potential parameters associated with an increased risk of micturition symptoms. In this retrospective analysis, we studied 283 consecutive patients with RRPC treated by SCT in three independent U.K. centres (between 2001 and 2011). Two freeze-thaw cycles of transperineal cryotherapy were performed under transrectal ultrasound guidance by a single surgeon in each of the 3 sites. We analysed clinico-pathological factors against tumour response. Functional outcomes were assessed by continence status and IPSS questionnaire. Predictive factors for SCT-induced micturition symptoms were analysed in a sub-group (n=42) of consecutive cases. We found that nadir post-SCT PSA levels strongly associated with DFS. The DFS rates at 12- and 36-month were 84% and 67% for the ≤ 1 ng/ml group and 56% and 14% for the >1 ng/ml group, respectively (p