Salvage Prostate Cryoablation for the Management of Local Recurrence After Primary Cryotherapy: A Retrospective Analysis of Functional and Intermediate-Term Oncological Outcomes Associated With a Second Therapeutic Freeze

Abstract

The purpose of the study was to examine the outcomes of salvage prostate cryoablation for managing patients with local recurrence after primary cryotherapy. The records of 108 patients treated with salvage prostate cryoablation for biopsy-proven local recurrence after primary cryotherapy were retrospectively reviewed. Oncological outcome was defined by the rate of biochemical recurrence (BCR) after salvage ablation using Phoenix criteria. Whole-gland (n= 91; 84.3%) or focal (n= 17; 15.7%) salvage cryoablation after failed primary cryosurgery were used. Fifty-eight of 108 patients (53.7%) had received androgen deprivation therapy (n= 35; 32.4%)/radiotherapy (n= 23; 21.3%) before salvage ablation. Two-year and 5-year BCR rates after salvage therapy were 28.2% and 48.3%, respectively. In univariate analysis, a higher Gleason score, D'Amico risk category (P< .0001) as well as prostate-specific antigen density >0.15 ng/mL/cc (P= .02) before second cryotherapy were significantly associated with the risk of BCR. In multivariable analysis, the only significant factor associated with risk of BCR after the second ablation was a higher presalvage D'Amico risk category (P= .008). Persistent urinary incontinence (1-4 pads per day) in 8 (7.4%), temporary urinary retention in 4 (3.7%), and rectourethral fistula in 4 (3.7%) patients were reported 1 year after second cryoablation. During the same period, 13.8% of patients were able to have either spontaneous or medication-augmented erections sufficient for intercourse. This series, to our knowledge, represents the largest cohort of patients who received 2 cryoablation treatments. Local failure after primary cryoablation can be salvaged by second cryosurgery with acceptable intermediate-term disease control. Patients should be counseled regarding the side effect profile associated with second cryoablation.