CUA 2018: Salvage Cryoablation for Recurrent Prostate Cancer Following Radiation Therapy: Long-Term Outcomes

Halifax, Nova Scotia ( Chin Joseph, MD, presented a study on salvage cryoablation for recurrent prostate cancer (PC) following radiation therapy (RT).

RT is a recommended treatment option for localized PC. An estimated 32% of patients fail locally and may be offered salvage therapy with either radical prostatectomy or ablative therapy, although most are only offered androgen deprivation therapy (ADT). Cryotherapy has proven to be safe in the radio-recurrent prostate cancer (RRPC) setting. However, no long-term comparison exists for the outcome of salvage cryotherapy vs. salvage radical prostatectomy.

The authors aimed to perform a combined analysis of two large cohorts of salvage cryotherapy (SCRYO) patients from the prospectively maintained databases of two tertiary referral centers (268 patients). The authors planned to assess the long-term results of the combined group, after a median follow-up time of 10.3 years. All patients had a negative bone scan and CT. The limitations of this study were that it was a nonrandomized prospective study, with no control group and limited baseline information from wide referral bases.

Overall, 436 complications had occurred in 199/268 patients, 381 were Clavien grade 1-2, 55 were Clavien grade 3. No mortalities had occurred 90 days after the procedure. Only 1.5% of the patients experienced rectourethral fistula, and 54.9% had some form of incontinence. Erectile dysfunction (ED) rates occurred in 24.6% of patients, but according to Joseph the ED data was less reliable.

The results of overall survival (OS), disease-specific survival (DSS), metastasis-free survival (MFS), CRPC free survival and ADT free survival are shown in figure 1. Neoadjuvant hormones were shown to improve DSS and repeat cryoablation was shown to worsen it.

In conclusion, SCRYO for RRPC provides long-term survival outcomes with 74% 15-year freedom from CRPC, 71% 15-year MFS, 70% 15-year DSS, and 54% 15-year OS. There is a high rate of ‘minor’ complications, affording an acceptable degree of overall treatment-related morbidity. Neoadjuvant ADT is associated with a decreased time to metastasis but improved OS and DSS. SCRYO results in a difference of or complete avoidance of ADT in a significant proportion of patients, which is a meaningful oncologic outcome metric. Lastly, SCRYO is a viable local salvage option for RRPC. It can be considered and offered as a local salvage option for histologically proven radiation failures in carefully screened patients.

UroToday CUA 2018 Salvage Cryoablation for Recurrent Prostate Cancer

Presented by: Chin Joseph, MD, Western University, London Health Sciences Centre — London, Canada

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia