Salvage Focal Cryotherapy Offers Similar Short-term Oncologic Control and Improved Urinary Function Compared With Salvage Whole Gland Cryotherapy for Radiation-resistant or Recurrent Prostate Cancer |
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| Affiliation: | 1. Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC;2. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH;3. Department of Urology, Medical School, Cairo University, Cairo, Egypt;4. Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH;5. Department of Urology, Menoufia University, Shebin Al Kom, Egypt;1. Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;2. Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;3. Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy;1. Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois;2. Department of Radiology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois;3. Radiation Oncology, University of Chicago Medicine, Chicago, Illinois;4. Washington University School of Medicine, St Louis, Missouri;5. University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah;6. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania;7. Departments of Radiology and Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK;1. Department of Urology, University of Turin, Turin, Italy;2. Department of Urology University Hospitals Leuven, Leuven, Belgium;3. Department of Urology, Mayo Clinic, Rochester, MN, USA;1. Department of Veterans Affairs, New York Harbor Healthcare, Brooklyn, NY;2. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY;1. Division of Surgery and Interventional Science, University College London, London, United Kingdom;2. Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom;3. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland |
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| Abstract: | BackgroundWe compared the short-term oncologic and functional outcomes of salvage focal cryotherapy (SFC) with those of salvage total cryotherapy (STC) for radiotherapy (RT)-persistent/recurrent prostate cancer.Materials and MethodsWe queried the Cryo On-Line Database registry for men who had undergone SFC and STC of the prostate for RT-persistent or recurrent disease. Propensity score weighting was used to match age at treatment, presalvage therapy prostate-specific antigen level, Gleason sum, and presalvage cryotherapy androgen deprivation therapy status. The primary outcome was progression-free survival.ResultsA total of 385 men with biopsy-proven persistent or recurrent prostate cancer after primary RT were included in the present study. The median follow-up, age, prostate-specific antigen, and Gleason sum before salvage cryotherapy was 24.4 months (first and third quartile, 9.8 and 60.3), 70 years (first and third quartile, 66 and 74 years), 4 ng/dL (first and third quartile, 2.7 and 5.6 ng/dL), and 7 (first and third quartile, 6 and 8), respectively. After propensity score weighting, the difference in progression-free survival was not statistically significant between the patients who had undergone STC and those who had undergone SFC (79.8% vs. 76.98%; P = .11 on weighted log-rank test). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs. 22.4%; P < .001). No significant differences were found in the incidence of rectal fistula (1.4% vs. 3.8; P = .30), new-onset urinary incontinence within 12 months (9.3% vs. 15.1%; P = .19), or new-onset erectile dysfunction within 12 months (52.6% vs. 59.6%; P = .47) between the SFC and STC groups, respectively.ConclusionsSTC resulted in similar 2-year oncologic outcomes compared with SFC in the RT-persistent/recurrent disease population. However, the patients who had undergone SFC had a lower urinary retention rate compared with those who had undergone STC. |
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| Keywords: | Focal cryotherapy Focal therapy Localized prostate cancer Radiotherapy Salvage cryotherapy |
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