Salvage cryosurgery for locally recurrent prostate cancer after primary cryotherapy.

OBJECTIVE

To report our preliminary experience of salvage cryosurgery (SCS) for locally recurrent prostate cancer (PCa) after primary cryotherapy and determine the efficacy of cryoablation of the prostate in the salvage setting.

PATIENTS AND METHODS

We conducted a retrospective review of the records of all patients who underwent SCS for locally recurrent PCa after primary cryotherapy between February 2008 and March 2012. Patients were assessed after treatment by prostate-specific antigen (PSA) testing, transrectal ultrasonography, radiologic imaging, and biopsy. Biochemical failure was defined using the Phoenix criteria.

RESULTS

Data from 12 patients who had undergone SCS were entered. Median age at SCS was 77.5 year. Before SCS, patients had a median PSA level of 2.5 ng/ml and median Gleason sum of 7. Patients underwent SCS at a median of 7.8 months after primary CS. Median PSA nadir after SCS was 1.32 ng/ml. The mean (range) follow-up was 33.5 months. Three patients were started on hormonal therapy for disease progression at a median post-SCS period of 12 months. Two patients underwent repeat cryoablation. Only one patient developed mild incontinence after SCS. Urethral sloughing occurred in one patient. Only two patients suffered from transient impotence.

CONCLUSIONS

It is feasible for patients with PCa to adopt SCS when primary cryotherapy has failed. The application of SCS also allows hormonal therapy to be deferred for a sufficient period of time.