Partial Salvage Cryoablation Of The Prostate For Recurrent Prostate Cancer After Radiotherapy Failure

UroToday.com - In the online edition of Urology, Drs. Michael Eisenberg and Katsuto Shinohara reported on their experience using partial (unilobar) cryotherapy for patients with a local recurrence of prostate cancer (CaP) following radiotherapy (XRT).

Between 2004 and 2007, 19 patients had failed XRT by either the ASTRO or Phoenix criteria. All had 16-core prostate biopsies performed to document recurrence, and metastatic evaluations were negative. Gleason grading post-XRT was not done. Only men with a unilobar recurrence underwent two to four probe cryoablation. Two to four freeze-thaw cycles were performed. Patients were discharged with an indwelling Foley catheter for 2-5 days.

No intra-operative or cancer-related deaths occurred. Salvage treatment was performed a mean of 6 years after primary XRT. Eleven men had received XRT alone and 8 also had an implant or high-dose boost. Mean prostate gland size was only 17cc and only 44% had identifiable lesions by TRUS. Ten men underwent repeat TRUS/biopsy one year later and in 9, no CaP was found. However, half of the biopsy cores obtained had some viable prostate tissue present. The 3-year biochemical recurrence-free survival rates according to the ASTRO and Phoenix definitions were 50% and 79%, respectively. All failures by both definitions had a PSA Doubling Time <12 months.

One patient had developed mild stress urinary incontinence, one developed a urethral stricture, one developed a prostatic urethral ulcer and one had prolonged rectal pain. This study underscores the need for careful patient selection in this difficult group of post-XRT recurrent CaP patients.

Eisenberg ML, Shinohara K
Urology. 2008 Jul 1. Epub ahead of print.
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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