Quality of life after salvage cryotherapy: The impact of treatment parameters

Purpose: Cryotherapy has emerged as a promising salvage therapy option for treatment of locally recurrent prostate cancer after initial therapy. In th is retrospective study we evaluate patient quality of life after salvage cr yotherapy and correlate complications impairing quality of life with specif ic cryotherapy treatment parameters, Materials and Methods: A modified UCLA Prostate Cancer Index measuring heal th related quality of life was sent to 150 patients who underwent salvage c ryotherapy between July 1992 and April 1995. We evaluated the relationships among incontinence, pain, impotence, sloughing of tissue and problematic v oiding symptoms, and cryotherapy treatment parameters, including use of a u rethral warming catheter, number of cryotherapy probes and number of freeze -thaw cycles. We also evaluated patient overall degree of satisfaction with the procedure. Results: Of 150 surveys 112 (74%) were returned. Mean followup was 16.7 mon ths (range 0.5 to 31.5). Treatment without an effective urethral warming ca theter was highly associated with urinary incontinence (p < 0.003), perinea l pain (p < 0.001), tissue sloughing (p < 0.003) and American Urological As sociation symptom score greater than 20 (p < 0.004). Impotence was higher i n the double freeze-thaw cycle group (p < 0.05). Overall satisfaction with cryotherapy was 33%. Conclusions: Quality of life may be compromised by urinary incontinence, im potence, tissue sloughing, problematic voiding symptoms and/or perineal pai n in a substantial number of patients following salvage cryotherapy. Effect ive urethral warming is essential in reducing complications and maximizing quality of life. Salvage cryotherapy does not appear to offer any quality o f life advantages compared to salvage prostatectomy.