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VAIL, CO USA (UroToday.com) - Introduction and Objectives: 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: Patients being considered for salvage therapy had biopsy proven recurrence, a prostate-specific antigen < 10, life expectancy >10 years, and a negative metastatic workup with CT and bone scan. Patients were followed to observe for PSA recurrence and toxicity of treatment. PSA recurrence was defined as any detectable value for patients who underwent prostatectomy and 3 consecutive rises in PSA for those who underwent cyroablation.
Results: From January 2004 to June 2013, a total of 23 salvage procedures were performed. 6 of those patients underwent salvage prostatectomy (AS) while 17 underwent salvage cryotherapy (NM) by two high volume fellowship trained urologists. With a mean follow up of 14.1 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 % vs 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 only one recto-urethral fistula in the cohort after salvage cryotherapy. Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort.
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. There was a trend towards improved oncologic outcomes and less complications with salvage prostatectomy in our series. We conclude that both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity and should be equally considered for radio-recurrent patients.
Source of Funding: none
Presented by Anup Vora, Josh Nething, Rodolfo Rivas, Dan Marchalik, Asra Jawed, Joel Calafell, Sneha Vaish, Barbara Ercole, Alok Shrivastava, and Nic Muruve at the 24th International Prostate Cancer Update - February 19 - 22, 2014 - Cascade Conference Center - Vail, Colorado USA