OBJECTIVE: To define the effects of androgen deprivation therapy (ADT) used prior to salvage cryoablation (SC) for the treatment of recurrent localized prostate cancer after radiation.
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METHODS: Patients from the Cryo On-Line Database registry undergoing SC after radiation failure were divided according to whether they had previously received or not received ADT. Baseline characteristics including demographics and presalvage cancer risk were compared. Biochemical progression-free survival (bPFS) as defined by the Phoenix criteria was compared between the 2 groups as a whole and also in D'Amico risk-stratified subgroups. In addition, postsurgical complications such as urinary fistula, retention, incontinence, and erectile dysfunction were compared.
RESULTS: Two groups consisting of 254 and 486 patients with and without pre-SC ADT were analyzed. The patients who received ADT were younger (P = .003) and had higher presalvage D'Amico risks (P < .001). The 5-year bPFS was 63.8% and 39.3% for the hormone-naïve and the pre-SC ADT patients, respectively (P < .001). On subgroup analysis, the difference in 5-year bPFS was significant only for patients with a high D'Amico cancer risk (54.3% vs 30.5%; P = .013). On multivariate analysis, presalvage prostate-specific antigen (hazard ratio [HR], 1.7), Gleason score ≥8 (HR, 2.5), and use of pre-SC ADT (HR, 1.7) correlated with biochemical recurrence. Additionally, patients receiving pre-SC ADT experienced less urinary retention (P = .001) and incontinence (P = .008) but were more likely to be impotent (P = .010).
CONCLUSION: Patients receiving ADT before SC, especially those with high-risk prostate cancer, had worse 5-year bPFS. Added caution is needed when selecting patients having previously received ADT for salvage cryotherapy.
Li R, Ruckle HC, Schlaifer AE, El-Shafei A, Yu C, Jones JS. Are you the author?
Department of Urology, Loma Linda University Medical Center, Loma Linda, CA; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Urology Department, Medical School, Cairo University, Giza, Egypt.
Reference: Urology. 2015 May;85(5):1137-42.