Following failed radiation therapy (RT) the best treatment of recurrent prostate cancer remains controversial due to the lack of long-term data. Researchers reviewed the survival and establish prognostic indicators for men who received salvage cryotherapy for biopsy-proven recurrent prostate cancer.

The researchers performed a retrospective analysis on men undergoing salvage cryotherapy at an academic urology unit for biopsy-proven locally recurrent prostate cancer after RT from 1995 to 2004. Preoperative, perioperative, and postoperative data were reviewed and recorded. The cryotherapy consisted of two freeze-thaw cycles of transperineal cryotherapy performed under transrectal ultrasound guidance by a single surgeon.

The primary outcome was survival and the secondary outcomes were disease-free survival (DFS), metastasis-free survival, and progression to androgen-deprivation therapy. They found that of 187 men, 176 had records available for follow-up (follow-up rate: 94%). Mean follow-up was 7.46 yr (range: 1-14 yr) and Fifty-two men were followed for >10 yr.

1- DFS at 10 yr was 39%.

2- Risk factors for recurrence were pre-salvage prostate-specific antigen (PSA), pre-radiation, and pre-salvage Gleason score.

3- A PSA nadir>1.0 ng/dl was highly predictive of early recurrence.

According to the researchers, salvage cryotherapy led to an acceptable 10-yr DFS and they concluded that pre-salvage PSA and Gleason score were the best predictors of disease recurrence. They also found that a PSA nadir >1 ng/dl following cryotherapy indicated a poor prognosis, and recurrence of disease was universal in these patients.

The research contained a few significant flaws that prohibit any generalizations from being drawn. The researchers only evaluated the work of one surgeon. They also failed to compare the results of cryotherapy against any other possible salvage therapy possibility, including surgery. Although ten years is a significant time period for follow up, in recurrent prostate cancer the next 5 years would probably be more valuable to have evaluated. Despite thee flaws, cryotherapy has come a long way and could prove itself an excellent alternative for salvage therapy as opposed to the more commonly used treatment, but very difficult to perform salvage surgery.

Williams AK, Martínez CH, Lu C, Ng CK, Pautler SE, Chin JL; European Urology (Dec 2010)

Joel T Nowak, M.A., M.S.W.