Salvage cryotherapy using an argon based system for locally recurrent prostate cancer after radiation therapy: The Columbia experience

Purpose: Cryosurgical ablation of the prostate has been reported as potenti al treatment for radioresistant clinically localized prostate cancer. We re port our experience with the safety and efficacy of salvage cryosurgery usi ng the argon based CRYOCare system (Endocare, Inc, Irvine, California). Materials and Methods: Between October 1997 and September 2000, 38 men with a mean age of 71.9 years underwent salvage cryosurgery for recurrent prost ate cancer after radiation therapy failed. All patients had biochemical dis ease recurrence, defined as an increase in prostate specific antigen (PSA) of greater than 0.3 ng./ml. above the post-radiation PSA nadir. Subsequentl y prostate biopsy was positive for cancer. Pre-cryosurgery bone scan demons trated no evidence of metastatic disease. In addition, these patients recei ved 3 months of neoadjuvant androgen deprivation therapy before cryotherapy . Results: The PSA nadir was 0.1 or less, 1 or less and greater than 1 ng./ml . in 31 (81.5%), 5 (13.2%) and 2 (5.3%) patients, respectively. Biochemical recurrence-free survival calculated from Kaplan-Meier curves was 86% at 1 year and 74% at 2 years. Reported complications included rectal pain in 39. 5% of cases, urinary tract infection in 2.6%, incontinence in 7.9%, hematur ia in 7.9% and scrotal edema in 10.5%. The rate of rectourethral fistula, u rethral sloughing and urinary retention was 0%. Conclusions: Our study supports cryosurgery of the prostate as safe and eff ective treatment in patients in whom radiation therapy fails. Using the CRY OCare machine resulted in a marked decrease in complications.