Salvage cryotherapy for recurrent prostate cancer after radiation therapy:The Columbia experience

Objectives. Cryotherapy of the prostate represents a potential treatment fo r localized recurrent prostate cancer after radiation therapy. We report ou r experience and evaluate the predictive factors for prostate-specific anti gen (PSA) recurrence. Methods. Between October 1994 and April 1999, 43 patients underwent salvage cryoablation. All patients had biopsy-proven recurrent prostate cancer wit hout seminal vesicle invasion, negative bone scans, and negative lymph node dissection. Patients had received 3 months of combined hormonal therapy be fore cryosurgery. Biochemical recurrence-free survival (bRFS) was defined a s a PSA value less than 0.1 ng/mL. Results. Complications included incontinence (9%), obstruction (5%), urethr al stricture (5%), rectal pain (26%), urinary infection (9%), scrotal edema (12%), and hematuria (5%). The mean follow-up was 21.9 months (range 1.2 t o 54). Twenty-six patients (60%) reached a serum PSA nadir less than 0.1 ng /mL, 16 (37%) had a PSA less than 4 ng/mL, and 1 (3%) had a PSA less than 1 0 ng/mL. The bRFS rate was 79% at 6 months and 66% at 12 months. The bRFS r ate was higher for patients who had an undetectable postcryotherapy PSA tha n for patients who did not reach a PSA less than 0.1 ng/mL (73% versus 30%, P = 0.0076). Using multivariate analysis, a PSA nadir greater than 0.1 ng/ mL was an independent predictor of PSA recurrence. Conclusions. Current salvage cryotherapy of the prostate can result in unde tectable serum PSA levels with low morbidity. Our data support the current safety and efficacy profile. We believe that cryotherapy is a viable option in the treatment of patients who have biopsy-proven local failure after ra diation therapy for prostate cancer. Further refinements in technique and e quipment may enhance cryosurgical results. (C) 2000, Elsevier Science Inc.