Salvage Cryoablation for Recurrent Prostate Cancer Following Primary External Beam Radiotherapy or Primary Cryotherapy: A Propensity Score Matched Analysis of Mid-term Oncologic and Functional Outcomes

• Published in: Clinical genitourinary cancer 2023-10, Vol.21 (5), p.555-562
• Main Authors: Campbell, Scott P., Deivasigamani, Sriram, Arcot, Rohith, Adams, Eric S., Orabi, Hazem, Elshafei, Ahmed, Tan, Wei Phin, Davis, Leah, Wu, Yuan, Chang, Andrew, Jones, J. Stephen, Polascik, Thomas J.
• Format: Article
• Language: English
• Subjects: Biochemical progression-free survival; Local recurrence prostate cancer; Oncologic outcomes; Salvage cryotherapy
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2023.06.015

Local prostate cancer recurrence following radiotherapy (XRT) or cryoablation (CRYO) may be addressed with salvage cryotherapy (SCT), although little is known about how the primary treatment modality affects SCT results. Oncologic and functional outcomes of patients who underwent SCT after primary XRT (XRT-SCT) or cryoablation (CRYO-SCT) were studied. Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression-free survival (BPFS).  Urinary incontinence, rectourethral fistula, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test and univariable/multivariable Cox proportional hazards (CPH) models were utilized to evaluate BPFS between groups. 419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that was reduced to 63 patients in each cohort after propensity matching. There was no difference in BPFS at 2 and 5 years both before (P = .5 and P = .7) and after matching (P = .6 and P = .3). On multivariable CPH, BPFS was comparable between treatment groups (CRYO-SCT, HR=1.1, [0.2-2.2]).  On the same analysis, BPFS was lower in D'Amico high-risk (HR 3.2, P < .01) and intermediate-risk (HR 1.95, P < .05) categories compared to low-risk. There was no significant difference in functional outcomes between cohorts. Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy. A retrospective study compared the oncologic and functional outcomes of salvage cryotherapy (SCT) after primary radiotherapy (XRT-SCT) and cryotherapy (CRYO-SCT). Survival analysis showed no difference in biochemical progression-free survival between cohorts at 2 and 5 years, and comparable functional outcomes, supporting that SCT may be used to treat local prostate cancer recurrence after XRT or Cryotherapy.