Salvage Cryoablation Research Articles

Cryotherapy versus radical prostatectomy as a salvage treatment for radio-recurrent prostate cancer.

The aim of this study is to compare outcomes of SRP (salvage radical prostatectomy) with SCAP (salvage cryoablation of the prostate) in local radio-recurrent PCa (prostate cancer) patients. A retrospective analysis of a multicentric European Society of Uro-technology (ESUT) database was performed. Data on patients with local recurrent PCa after radiotherapy who underwent salvage treatment were collected. Patients and their respective disease characteristics, perioperative complications as well as oncological outcomes were then described. The treatment success rate was defined as PSA nadir < 0,4 ng/ml. Any complications were graded according to the modified Clavien system. A descriptive and comparative analysis was performed using SPSS software. 25 patients underwent SRP and 71 patients received SCAP. The mean follow-up was 24 months. The median PSA level before initial treatment was 8.3 (range 7-127) ng/ml. The success rates of SRP and SCAP were largely comparable (88% (22 patients) vs. 67.7% (48 patients), respectively, p = 0.216). The mean serum PSA levels at 12 months after salvage treatment were 1.2 ± 0.2 ng/mL vs. 0.25 ± 0.5 ng/mL, p > 0.05). During the follow-up period, only 3 (12%) patients in the SRP group had PSA recurrence compared with 21 patients (29.6%) in the SCAP group. The 5-year BRFS was similar (51,6% and 48,2%, p = 0,08) for SRP and SCAP respectively. The 5-year overall survival rate was 91.7%, and 89,7% (p = 0.669) and the 5-year cancer-specific survival was 91.7%, and 97,1% (p = 0.077), after SRP and SCAP respectively. No difference was found regarding the complications. Both SRP and SCAP should be considered as valid treatment options for patients with local recurrence of PCa after radiotherapy. SCAP has a potentially lower risk of morbidity and acceptable intermediate-term oncological efficacy, but a longer follow up and a higher number of patients is ideally needed to draw any long-term conclusions regarding the oncological data.

Salvage Cryoablation for Recurrent Prostate Cancer Following Radiation-A Comprehensive Review.

The treatment options for prostate cancer typically entail active surveillance, surgery, radiation, or a combination of the above. Disease recurrence remains a concern, with a wide range of recurrence rates having been reported in the literature. In the setting of recurrence, the salvage treatment options include salvage prostatectomy, salvage high-intensity focused ultrasound (HIFU), stereotactic body radiotherapy (SBRT), salvage brachytherapy, and salvage cryoablation. In this review, we analyze the currently available data related to salvage cryoablation for recurrent prostate cancer following radiation.

Salvage Cryoablation for Recurrent Prostate Cancer Following Primary External Beam Radiotherapy or Primary Cryotherapy: A Propensity Score Matched Analysis of Mid-term Oncologic and Functional Outcomes.

Local prostate cancer recurrence following radiotherapy (XRT) or cryoablation (CRYO) may be addressed with salvage cryotherapy (SCT), although little is known about how the primary treatment modality affects SCT results. Oncologic and functional outcomes of patients who underwent SCT after primary XRT (XRT-SCT) or cryoablation (CRYO-SCT)were studied. Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression-free survival (BPFS). Urinary incontinence, rectourethral fistula, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test and univariable/multivariable Cox proportional hazards (CPH) models were utilized to evaluate BPFS between groups. 419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that was reduced to 63 patients in each cohort after propensity matching. There was no difference in BPFS at 2 and 5 years both before (P=.5 and P=.7) and after matching (P=.6 and P=.3). On multivariable CPH, BPFS was comparable between treatment groups (CRYO-SCT, HR=1.1, [0.2-2.2]). On the same analysis, BPFS was lower in D'Amico high-risk (HR 3.2, P < .01) and intermediate-risk (HR 1.95, P < .05) categories compared to low-risk. There was no significant difference in functional outcomes between cohorts. Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy.

Salvage Cryoablation and Robotic Seminal Vesiculectomy: A Novel Salvage Treatment for Locally Recurrent Prostate Cancer.

Purpose: The purpose of this article was to describe a novel salvage surgical technique combining cryoablation of the prostate and robotic excision of the seminal vesicle (SV) for locally recurrent prostate cancer (LRPC) of the SV with or without prostate involvement following radiation therapy (RT) or focal therapy (FT). Materials and Methods: Seven men with biopsy-proven LRPC involving the SV with or without adjacent prostate following primary RT or FT underwent combined salvage focal cryoablation (FCA) and robotic excision of the SV. Descriptive statistics characterized the cohort and outcomes. Results: Median follow-up was 1.4 years. There were no surgical complications, and the length of stay was 1 day in all cases. No patients experienced any new urinary incontinence following removal of the catheter. Erectile function was preserved in both men exhibiting preoperative erections adequate for intercourse. Of the four patients developing recurrent disease, three involved only the contralateral SV; they all underwent a second salvage FCA and robotic seminal vesiculectomy (RSV). One patient presenting with high-risk disease developed systematic metastasis. He is alive and managed with androgen deprivation therapy (ADT). One patient developed persistent local disease recurrence and is on ADT. The other five patients are disease-free based on the most recent multi-parametric magnetic resonance imaging (mpMRI) and prostate specific antigen (PSA). Conclusions: This study highlights the feasibility and effectiveness of salvage FCA and RSV as a salvage treatment for LRPC of the SV with or without involvement of the prostate following primary RT or FT. Based on our outcomes, we recommend considering a bilateral salvage FCA and RSV in men with unilateral SV recurrence following primary RT. We recommend unilateral salvage FCA and seminal vesiculectomy in men with unilateral SV and prostate involvement following primary partial cryoablation provided no contralateral disease is identified.

MP71-01 CIRCUMCORPORAL ARTIFICIAL URINARY SPHINCTER (CC-AUS): A NOVEL SURGICAL APPROACH FOR THE TREATMENT OF COMPLEX MALE STRESS URINARY INCONTINENCE (SUI)

You have accessJournal of UrologyCME1 Apr 2023MP71-01 CIRCUMCORPORAL ARTIFICIAL URINARY SPHINCTER (CC-AUS): A NOVEL SURGICAL APPROACH FOR THE TREATMENT OF COMPLEX MALE STRESS URINARY INCONTINENCE (SUI) Jeff Brady, Adam Procunier, Kevin Slagoski, Roshane Perera, Isabella Delbakhsh, and Brandon Foley Jeff BradyJeff Brady More articles by this author , Adam ProcunierAdam Procunier More articles by this author , Kevin SlagoskiKevin Slagoski More articles by this author , Roshane PereraRoshane Perera More articles by this author , Isabella DelbakhshIsabella Delbakhsh More articles by this author , and Brandon FoleyBrandon Foley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The CIRCUMCORPORAL AUS (CC-AUS) is an innovative approach for patients with compromised urethras previously not candidates for replacement of an AUS. Men who have had prior AUS erosions, with simultaneously compromised corpora cavernosa, may no longer be suitable candidates for available techniques, such as the transcorporal AUS (TC-AUS). This is a single surgeon (JB) review of the outcomes of the CIRCUMCORPORAL-AUS where the cuff is placed around all three corporal bodies. METHODS: This is a retrospective study on a database of AUS surgical outcomes. From 2000 to present, 611 AUS procedures were performed. Of these, 12 CC-AUS procedures were performed between Feb 2016 and Nov 2022. 10 have had sufficient follow up after AUS activation and are included in the analysis. Of the 7 patients with prostate cancer, all had radiation therapy (XRT). 5 had a radical prostatectomy with adjuvant XRT, 1 had EBRT alone and 1 had XRT with salvage cryoablation. One patient had a traumatic pelvic fracture with a bladder neck injury. The average cuff size was 8.98 cm. Patients were surveyed pre- and post-operatively and scored the severity of their incontinence in pads/day, improvement vs pre-op SUI, comparison to their first AUS and if they would have the surgery again. Outcomes were analyzed using 2 tailed T-test. RESULTS: Mean follow up is 2.5 years (1.3 to 6.5 years). There was a decrease from 9.9 to 3.34 pads/day (p=0.002). 100% of patients noted SUI improvement from pre-op (prior to CC-AUS). When compared to the first AUS, 44% felt they were “more dry”, 11% were similar and 44% felt “less dry”. All patients would have surgery again or would recommend to a friend. No patients reported urinary retention, change in penile sensation, glans necrosis, infections, or AUS malfunction. 2 patients required downsizing of their cuffs, and both had improvement. One patient had an erosion (ventral) of his CC-AUS with removal. CONCLUSIONS: This is the first report of the CIRCUMCORPORAL AUS. It appears to be a safe and effective surgical option for SUI in complex cases with prior AUS erosions. It has been successful in patients following XRT and multiple prior erosions. There have been no sensory or penile vascular changes noted. Longer term follow up is required to determine if results are durable. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1013 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeff Brady More articles by this author Adam Procunier More articles by this author Kevin Slagoski More articles by this author Roshane Perera More articles by this author Isabella Delbakhsh More articles by this author Brandon Foley More articles by this author Expand All Advertisement PDF downloadLoading ...

MP73-18 INTERMEDIATE-TERM ONCOLOGIC AND FUNCTIONAL OUTCOMES AFTER SALVAGE CRYOABLATION FOR LOCALIZED, BIOPSY-PROVEN RECURRENT PROSTATE CANCER FOLLOWING PRIMARY EXTERNAL BEAM RADIOTHERAPY VERSUS PRIMARY CRYOTHERAPY

You have accessJournal of UrologyCME1 Apr 2023MP73-18 INTERMEDIATE-TERM ONCOLOGIC AND FUNCTIONAL OUTCOMES AFTER SALVAGE CRYOABLATION FOR LOCALIZED, BIOPSY-PROVEN RECURRENT PROSTATE CANCER FOLLOWING PRIMARY EXTERNAL BEAM RADIOTHERAPY VERSUS PRIMARY CRYOTHERAPY Scott P. Campbell, Rohith Arcot, Sriram Deivasigamani, Eric S. Adams, Hazem Orabi, Ahmed Elshafei, Wei Phin Tan, Leah Davis, Yuan Wu, Andrew Chang, J Stephen Jones, and Thomas J Polascik Scott P. CampbellScott P. Campbell More articles by this author , Rohith ArcotRohith Arcot More articles by this author , Sriram DeivasigamaniSriram Deivasigamani More articles by this author , Eric S. AdamsEric S. Adams More articles by this author , Hazem OrabiHazem Orabi More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Wei Phin TanWei Phin Tan More articles by this author , Leah DavisLeah Davis More articles by this author , Yuan WuYuan Wu More articles by this author , Andrew ChangAndrew Chang More articles by this author , J Stephen JonesJ Stephen Jones More articles by this author , and Thomas J PolascikThomas J Polascik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Local prostate cancer recurrence following treatment with external beam radiation (XRT) or cryotherapy may be treated with salvage cryotherapy (SCT), but little is known about how the primary treatment modality influences SCT outcomes. We compare the oncologic and functional outcomes of patients who received whole- or partial-gland SCT after primary XRT (XRT-SCT) or primary cryoablation (CRYO-SCT). METHODS: The Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry were used to analyze data on XRT-SCT and CRYO-SCT patients. Propensity score matching was performed with variables selected that had an impact on oncologic outcomes. The primary outcome was biochemical progression-free survival (BPFS), as defined by the Phoenix criteria. Urinary incontinence, rectourethral fistula formation, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test, as well as Cox proportional hazards modelling, were used to compare BPFS rates and identify factors influencing BPFS. To identify factors that can predict biochemical recurrence (BCR), a multivariate logistic regression analysis was performed. RESULTS: 419 XRT-SCT and 63 CRYO-SCT patients met the inclusion criteria, which was reduced to 63 patients in each cohort after propensity matching. On the 2- and 5-year Kaplan-Meier log-rank tests, no difference in BPFS was found. In multivariate analysis, the CRYO-SCT group had similar rates of BCR as compared to XRT-SCT (OR=1.63; p=0.2). For both groups, higher (OR=36.38; p=0.03) and intermediate (OR 8.26; p=0.01) D’Amico risk category was associated with higher rates of BCR relative to low-risk. There were no significant differences in post-salvage changes to functional outcomes. CONCLUSIONS: Oncologic and functional outcomes following salvage cryoablation appear to be similar for well-matched patients who underwent XRT-SCT or CRYO-SCT. Risk category was an important predictor of oncologic outcomes, suggesting the importance of close follow-up after primary treatment to promote early salvage treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1042 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott P. Campbell More articles by this author Rohith Arcot More articles by this author Sriram Deivasigamani More articles by this author Eric S. Adams More articles by this author Hazem Orabi More articles by this author Ahmed Elshafei More articles by this author Wei Phin Tan More articles by this author Leah Davis More articles by this author Yuan Wu More articles by this author Andrew Chang More articles by this author J Stephen Jones More articles by this author Thomas J Polascik More articles by this author Expand All Advertisement PDF downloadLoading ...

Tratamiento percutáneo del cáncer infiltrante de mama en estado clínico I/II mediante crioablación en pacientes sin indicación de cirugía axilar

ObjectiveTo review the efficacy of percutaneous treatment of infiltrating breast cancer (BC) by ultrasound-guided cryoablation in patients with clinical stage I/II without indication for axillary surgery MethodsPatients with clinical stage I/II BC who were treated by ultrasound-guided cryoablation in whom axillary surgery was ruled out were collected from our files. Patients who had a minimum follow-up of 12 months were selected. The ultrasound follow up were: the first between 1-2 months (to assess residual lesions due to incomplete treatment) and subsequently every six months (to assess recurrences). Residual lesions and recurrences were confirmed with CNB and in all cases treatment with new (salvage) cryoablation was considered. The efficacy of the procedure was assessed on local control in the breast. ResultsBetween March 2019 and September 2022, 84 patients with 92 BC in clinical stage I/II were treated with ultrasound-guided cryoablation without indication for axillary surgery. The inclusion criteria of the retrospective study were met by 43 patients (58-96 years, mean 83, SD ±7,64) with 48 BC (between 5-60mm, mean 17, SD ±13,75) who were reviewed during a mean period of 20 months (between 12-40 months). There were two patients with incomplete treatment at the first ultrasound and five patients relapsed (between 9-27 months, mean 17). All were treated with salvage cryoablation. Local control at 12 months was 90.5% (probability 0.905 standard error 0.045) and in 95% of patients (41/43) the BC was locally controlled. Six patients died, three due to progression of the BC and three due to other causes. All procedures were well tolerated and there were no serious complications. ConclusionUltrasound-guided cryoablation is an effective percutaneous treatment for the local control of BC in patients with clinical stage I/II without indication for axillary surgery.

Salvage Cryoablation for Local Recurrences of Thyroid Cancer Inseparable from the Trachea and Neurovascular Structures

PurposeTo demonstrate safety, feasibility, and effectiveness of cryoablation of recurrent papillary thyroid cancer ineligible for reoperation because of scarring, eligible for focal ablation as defined within 2015 American Thyroid Association guideline sections C16 and C17. Materials and MethodsWith multidisciplinary consensus, cryoablation was performed with curative intent for 15 tumors in 10 patients between January 2019 and July 2021. Demographics, procedural details, and serial postprocedural imaging findings were analyzed. ResultsThe mean age was 72.5 years (range, 57–88 years), and 80% of the patients were women. The tumors (mean size, 16 mm ± 6; range, 9–29 mm) received 1 session of cryoablation with 100% technical success. The mean and median postcryoablation tumor volumetric involution rates were 88% and 99%, respectively, with 9 (60%) of 15 tumors involuting completely or down to the scar and 6 (40%) involuting partially at the end of the study period. Tumor size did not increase after cryoablation (0% local progression rate). All tumors abutted the trachea, skin, and/or vascular structures, and hydrodissection failed in all cases because of scarring. The major adverse event rate was 20% (3/15), with 2 cases of voice change and 1 case of Horner syndrome; all resolved at 6 months with no permanent sequelae. No vascular, tracheal, dermal, or infectious adverse events occurred during a mean follow-up of 242 days (range, 114–627 days). One patient died at 386 days after cryoablation because of unrelated cholangiocarcinoma. ConclusionsCryoablation of local recurrences of papillary thyroid cancer abutting the trachea and/or neurovascular structures in the setting of hydrodissection failure because of scarring yielded a mean volumetric involution of 88%, primary efficacy of 60%, and objective response rate of 100% with no local recurrences or permanent complications during a mean follow-up of 242 days. The secondary efficacy and longer-term outcomes remain forthcoming.

Residue and recurrence in percutaneous cryoablation for cT1 renal tumor: Clinical utility and feasibility of salvage cryoablation with iodized oil marking.

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Comparative Study Between Salvage Cryoablation of The Prostate After Primary Radiotherapy Failure and After Primary Cryotherapy Failure For Clinically Localized Prostate Cancer

Comparative Study Between Salvage Cryoablation of The Prostate After Primary Radiotherapy Failure and After Primary Cryotherapy Failure For Clinically Localized Prostate Cancer

Prostatic dystrophic calcification following salvage cryotherapy for prostate cancer – an under-reported entity?

Background Salvage cryoablation (SCA) is an accepted treatment for radio-recurrent prostate cancer with well-established oncological and functional outcomes. Based on one of the longest reported prospective follow-ups in the literature (median 12 years) on 187 patients, this study reports what appears to be an under-appreciated finding in eight patients with dystrophic calcifications (DC) of the prostate following SCA, causing severe bladder outlet obstruction. Materials and methods Between 1995 and 2004, 187 patients underwent SCA, with a median follow-up of 12 years. This database was reviewed for functional and oncological outcomes and DC were evaluated. Results Functional data was available in 85 patients, amongst whom eight patients were found to develop DC (9.4%) proven when the patients presented with urinary difficulties and attempted transurethral resection was undertaken for bladder outlet obstruction. Mean time for emergence of significant symptoms of bladder outlet obstruction was 8.6 years from SCA (standard deviation (SD) = 6 years). All eightpatients required permanent drainage (seven suprapubic catheters, one nephrostomy). All patients with DC experienced biochemical recurrence (BCR), compared to 57.1% of the patients with no DC (p = 0.01). Conclusion DC following SCA appears to be an under-reported late adverse effect which may only become evident with long follow-up, and should be included in preoperative counselling.

MP70-20 OUTCOMES OF SALVAGE CRYOABLATION FOR LOCALIZED RADIO-RECURRENT PROSTATE CANCER: A SINGLE SURGEON EXPERIENCE

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (MP70)1 Apr 2020MP70-20 OUTCOMES OF SALVAGE CRYOABLATION FOR LOCALIZED RADIO-RECURRENT PROSTATE CANCER: A SINGLE SURGEON EXPERIENCE Achankeng Afiadata*, Paul Prillaman, and Robert Given Achankeng Afiadata*Achankeng Afiadata* More articles by this author , Paul PrillamanPaul Prillaman More articles by this author , and Robert GivenRobert Given More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000950.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cryoablation is a well-known versatile treatment modality for localized prostate cancer with reasonable functional outcomes. It is readily used in the setting of radio-recurrent, localized disease as opposed to salvage prostatectomy owing to less associated morbidity. Literature on long-term outcomes of salvage cryoablation is sparse. We investigated the oncologic outcomes and complications of salvage cryoablation for localized, radio-recurrent prostate cancer. METHODS: Retrospective review of patients who underwent salvage cryoablation for radio-recurrent prostate cancer at our institution from 2003 to 2019. Included patients had biopsy-proven local recurrence, and negative metastatic workup. Preoperative data, follow-up, oncologic outcomes, and associated morbidity were obtained. RESULTS: Eighty-six patients had salvage cryoablation for localized, radio-recurrent prostate cancer at our institution during the 16-year period. Mean age (SD) of patients was 71 (8), with Caucasian males making up 59% of the population. Majority of patients had prior external beam radiotherapy (EBRT), 82.6%, with a mean pre-cryoablation PSA (SD) of 2.5 (0.9) ng/mL. Median (IQR) follow up was 55.2 (21-94.8) months. Forty-two patients had no evidence of disease (NED), 52% of patients with pre-PSA of <4 had NED compared to 44.4% for pre-PSA ≥4. Median (IQR) biochemical free survival was 64 (30-140) months; 75 (36-140) months for pre-PSA <4, and 48 (24-84) months for pre-PSA ≥4 (P=0.0735). Long-term associated morbidities included: incontinence (26.7%), urethral stricture/stenosis (24.7%), and fistula (3.5%). CONCLUSIONS: Earlier (PSA <4 ng/mL) salvage cryoablation for localized radio-recurrent prostate cancer portends better oncological outcomes. Counsel patients on high rate of long-term incontinence and urethral stricture/stenosis associated with treatment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1063-e1063 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Achankeng Afiadata* More articles by this author Paul Prillaman More articles by this author Robert Given More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of salvage cryoablation with decreased utilization of androgen deprivation therapy for recurrent prostate cancer after radiotherapy.

358 Background: Cryoablation is an established treatment for recurrent prostate cancer after primary radiotherapy, but outcomes data are mostly limited to uncontrolled case series. We assessed salvage cryoablation efficacy with a comparative analysis in a large national cohort. Methods: Patients with clinically localized prostate cancer treated with primary radiotherapy from 2000 to 2015 were identified in the Veterans Affairs Informatics and Computing Infrastructure (VINCI) dataset. Prostate-specific antigen (PSA) recurrence was defined as nadir + 2 ng/mL. Inclusion criteria included availability of serial PSA measures for ≥ 3 years after completion of radiotherapy and PSA &lt; 10 ng/mL at recurrence. Salvage cryotherapy was identified with procedure- and fee-based billing codes. Chi square and Wilcoxon analysis was utilized for descriptive statistics; and Kaplan Meier analyses for time to androgen deprivation therapy (ADT). Results: Among 35,502 patients who underwent primary radiotherapy, 4,391 (12.3%) developed biochemical recurrence a median (IQR) of 4.5 (2.7, 6.9) years after treatment. Of these, 3889 (88.9%) had PSA &lt; 10 ng/mL at time of recurrence, of whom 95 (2.4%) underwent salvage cryoablation. Cryoablation patients were younger at initial diagnosis (60 years versus 65 years, p &lt; 0.01); had a lower pre-treatment PSA (6.6 ng/mL versus 7.8 ng/mL, p &lt; 0.01); and had a lower PSA nadir (0.04 ng/mL versus 0.19 ng/mL, p&lt;0.01). There were no between-group differences for clinical stage at initial diagnosis (p = 0.22) or African American prevalence (34.7% versus 29%, p =0.27). After recurrence, median (IQR) follow-up for those who did and did not receive cryoablation was 9.1 (7.2, 9.11) and 8.1 (5.4, 10.9) years, respectively. Cryoablation patients were less likely to receive ADT (40% versus 55%, p &lt; 0.01); and, among those who did, time to ADT from recurrence was significantly longer compared to those who did not receive cryoablation (15.5 months versus 5.8 months, p&lt;0.01). Conclusions: Salvage cryoablation is associated with decreased utilization of ADT in patients with biochemical recurrence after radiation.

Rectal wall saline displacement for improved margin during MRI-guided cryoablation of primary and recurrent prostate cancer.

To describe safety, efficacy, and added oncologic margin of saline displacement of the rectal wall during MRI-guided cryoablation of primary and recurrent prostate cancer. A retrospective review was conducted for patients who underwent MRI-guided cryoablation with saline displacement of the rectal wall for treatment of primary and recurrent prostate cancer over a 2-year period. Saline displacement was used when the distance from the edge of the ablation area to the rectal wall was insufficient to provide at least a 5-mm treatment margin. Pre- and post-ablation rectal wall displacement distances as well as ablative zone margins were assessed with MRI. Saline displacement distance was measured from the rectal wall to the edge of the lesion for focal lesion ablation and from the edge of the prostate for hemi-gland ablation. Immediate and intermediate-term complications were assessed. Saline displacement was used in 25 patients undergoing MRI-guided cryoablation. Twenty-one patients underwent salvage cryoablation, while four patients had it as primary treatment for prostate cancer. Median pre- and post- saline displacement rectal wall displacement distances were 6.0 and 11.2mm, respectively (P < 0.0001). Median-added oncologic margin achieved by saline displacement was 4.6mm (range 0.6-26.5). Median follow-up was 14months (range 5-29). There were no intra-procedural complications and 3 patients experienced minor (Clavien-Dindo grade I) complications. One rectal complication occurred in a patient undergoing salvage cryotherapy with a history of extensive pelvic surgery and radiation. Saline infusion at the time of MRI- guided cryoablation for prostate cancer resulted in increased distances between the target lesion and rectum. This is a useful technique in providing an added oncologic margin when treating lesions close to the rectal wall.

Salvage cryoablation for local recurrence of prostatic cancer after curative therapy

PurposeThe purpose of this study was to determine the efficacy of salvage cryotherapy for intra-prostatic and local extraprostatic recurrences after curative treatment of prostate adenocarcinoma. Material and methodTwenty-eight men (mean age, 69±6 [SD] years; range: 51–82 years) treated with cryoablation for prostatic (N=21) or extraprostatic (N=7) recurrent prostate cancer after radiotherapy with or without associated prostatectomy were included. Technical success, complication and recurrences were reported. Biological recurrence was defined as an elevation ≥2ng/mL of prostate specific antigen (PSA) serum level after the treatment. ResultsThe mean follow-up was 18 months. Among the 21 patients with intraprostatic recurrence, 14 had successful cryotherapy with a mean decrease in serum prostate-specific antigen (PSA) levels of −5.7±2.6 (SD) ng/mL (range: −2.1 to −16.9ng/mL). Four patients (19%) had early progression and three patients (14%) had delayed biological recurrence (mean time: 15 months). Among the 7 patients with extraprostatic recurrence, 2/7 (291%) had successful cryotherapy with a decrease in PSA serum level of −2.7±1.6 (SD) ng/mL (range: −0.5–−5.5ng/mL) and 4/7 (57%) had early biological recurrence after cryotherapy that required androgen deprivation therapy, whereas 1/7 (4%) was lost to follow-up. No major complications were observed for both intra- and extraprostatic recurrence. ConclusionSalvage cryoablation of locally recurrent prostate cancer after curative treatment is feasible and safe when the half prostate is treated. It could delay initiation of androgen deprivation therapy in these patients.

Salvage Cryoablation for Radiorecurrent Prostate Cancer: Initial Experience at a Regional Health Care System.

Local recurrence after radiotherapy for prostate cancer remains challenging to treat effectively. Although oncologic control is highest with salvage prostatectomy, the procedure is associated with substantial morbidity. To identify factors associated with successful salvage cryoablation for radiorecurrent prostate cancer. We retrospectively reviewed the medical records of patients who underwent salvage cryoablation at our institution between 2005 and 2015. All patients had biopsy-proven local recurrence after radiotherapy. Patients with seminal vesicle invasion or metastases were excluded. Complete follow-up was obtained for all patients. Primary study endpoint was biochemical progression-free survival based on the Phoenix criteria. Seventy-five patients underwent salvage cryotherapy. Mean patient age was 69.3 years. The overall biochemical salvage rate was 50.7% at a median follow-up of 3.9 years. The following factors were independently associated with successful cryotherapy: Precryotherapy Gleason score of 3 + 3 or 3 + 4, low precryotherapy prostate-specific antigen (PSA), low precryotherapy PSA density, longer time to PSA nadir after radiotherapy, and low postcryotherapy PSA nadir. A postcryotherapy PSA nadir of 0.5 ng/mL or less was associated with a biochemical progression-free survival of 79.7% at 3 years and 64.7% at 5 years, whereas a postcryotherapy PSA nadir above 0.5 was associated with a biochemical progression-free survival of 5.6% at 3 years and 0% at 5 years (p < 0.0001). Approximately 50% of the patients achieved biochemical salvage with cryoablation at 5 years. Nadir PSA after salvage was the strongest predictor of biochemical progression-free survival in our cohort.

SALVAGE CRYOABLATION TARGETING RECURRENT LESIONS AFTER DEFINITIVE RADIOTHERAPY FOR PROSTATE CANCER: IMPACT OF POST CRYOABLATION CHANGE IN URINARY AND SEXUAL FUNCTION

(Purpose) To describe our initial experience in salvage cryoablation targeting recurrent lesions after definitive irradiation for prostate cancer. (Methods) Eligible patients for this treatment were those who developed biochemical failure after definitive radiotherapy for localized prostate cancer, but without distant metastasis, and with solid lesions identifiable on multiparametric magnetic resonance imaging (mpMRI). Histological proof of recurrence with mapping biopsy covering corresponding sites was obtained. Two to four cryoprobes were inserted transperineally into the prostate under general anesthesia with extensive lithotomy position. The rapid expansion of argon gas cryogen through a small opening within the cryoprobe cools itself to make an ice ball and the quick exchange to helium gas induces an active thawing phase. Entire procedure is monitored and guided with the use of transrectal ultrasonography. Postoperative follow-up included patient interview, digital rectal examination, prostate specific antigen (PSA) testing and quality of life (QOL) monitoring using IPSS and IIEF-5 at 1, 3, 6 and 12 months postoperatively. Changes of mpMRI findings with time, particularly at one month, were used to judge immediate treatment impact. (Results) Five patients underwent salvage cryoablation between October 2015 and September 2016. No grade 3/4 complications such as rectal fistula or urethral stenosis were experienced. Mean and maximal percent decline of PSA from baseline levels at 1, 3, 6 and 12 months following cryoablation were 72.2 and 94.7%, 79.4% and 93.9%, 78.2% and 92.1%, 79.6% and 90.9%, respectively. Posttreatment IPSS showed temporary worsening with average changes in score of 1.8, 1.5, 1.6, and 1.0 times over baseline levels, respectively. IPSS score returned to the baseline in one at six months and two at 12 months. Two of 5 patients were sexually active prior to therapy and thus evaluable. Both showed significant decline in IIEF score by 95% at 12 months. No patients showed any signs of recurrence. mpMRI at one month following cryoablation confirmed complete disappearance of visible lesions in all cases. (Conclusions) Salvage cryoablation for recurrent lesions of prostate cancer after definitive radiotherapy is feasible with minimal morbidity. Both oncological outcome and adverse events should be monitored carefully with longer follow up.

Avoidance of androgen deprivation therapy in radiorecurrent prostate cancer as a clinically meaningful endpoint for salvage cryoablation.

To investigate the ability of salvage cryoablation of the prostate (SCAP) to delay the need for androgen deprivation therapy (ADT) in local recurrence after radiation therapy to the prostate using the Cryo-On-Line Database (COLD) registry. The COLD registry is comprised of a combination of retrospectively and prospectively collected data on patients undergoing primary and SCAP. Patients with local recurrence after radiation therapy were identified. Kaplan-Meier analysis was used to calculate ADT-free survival. We identified 898 patients that have undergone SCAP in the COLD registry. Overall, the calculated 5-year ADT-free survival probability was 0.713. When stratified by D'Amico risk group, 264 high-risk patients (71.9%), 234 intermediate-risk (86.7%),and 228 low-risk (87.7%) were free of ADT post-SCAP. This correlates with a 5-year ADT-free survival of 60.7, 73.9, and 82.4%, respectively. Patients with post-SCAP PSA nadir of <0.2 ng/mL had a 5 year ADT-free survival of 87.1% compared to 48.7% with a PSA nadir ≥0.2 ng/mL. Pre-operative ADT use or full versus partial gland SCAP did not have an effect on ADT use post-operatively. In 118 (55.4%) of patients with post-operative biochemical recurrence, ADT was not used. For patients with local recurrence after radiation, SCAP is an option that provides a high chance of avoiding or delaying ADT. The potential to delay ADT and its associated side effects should be a part of counseling sessions with the patient when discussing treatment options for locally recurrent prostate cancer after radiation. Avoidance of ADT is more clinically relevant than PSA elevation.

Effect on cryoablation of high-risk and locally recurrent prostate cancer: a Meta-analysis

Objective: To discuss the curative effect and prognosis of cryoablation to high-risk and locally recurrent prostate cancer patients. Methods: Cryoablation related publications and relevant references were searched for potential pertinent articles until March, 2016.Articles were selected according to the exclusion criteria, Stata ver.11 was used to perform the statistical analysis. Results: 5-year biochemical disease-free survival of salvage ablation for prostate cancer was 45%(95% CI 0.43-0.47), in salvage radiotherapy of 45% (95% CI 0.44-0.47). The 5-year biochemical disease-free survival of high-risk prostate cancer cryoablation was 66%(95% CI 0.64-0.67). The result of high-risk prostate cancer radiotherapy and EBRT were respectively 61%(95% CI 0.60-0.63) and 54% (95% CI 0.52-0.56). Conclusions: The five-year biochemical recurrence of salvage cryoablation is similar to salvage radiotherapy. For high-risk prostate cancer, cryoablation shows an advantage than traditional EBRT radiation.

Prostate Specific Antigen Nadir of 0.1 or Less Is a Predictor of Treatment Success in Men Undergoing Salvage Whole Prostate Gland Cryoablation.

To assess factors that affect prostate biopsy results following salvage whole gland cryoablation. One hundred seventy-four patients underwent prostate biopsy following salvage whole gland cryoablation of the prostate in the Cryo-OnLine Database registry. Wilcoxon rank-sum and χ2 tests and logistic regression analysis were used to assess predictors of positive biopsy. Prostate specific antigen (PSA) nadir was divided into a statistical tertile for comparisons between different nadir PSA cut points. Fifty-two of 174 (29.9%) of this highly select group of men who underwent biopsy had a posttreatment biopsy demonstrating malignant cancer. Men who had positive biopsy following salvage therapy had significantly higher median nadir PSA, shorter median time to prostate biopsy, and shorter median time to biochemical failure. Compared to the lowest tertile (PSA nadir defined as ≤0.1 ng/mL), PSA in the second tertile (0.11-0.8 ng/mL) and third tertile (>0.8 ng/mL) demonstrated increased odds ratio (OR) for positive biopsy, 4.34 (95% confidence interval [CI] 1.66, 11.4, p = 0.003) and 2.81 (95% CI 1.14, 7.00, p = 0.02), respectively, in adjusted models. In addition, men with a presalvage PSA >20 (OR 7.65; 95% CI 2.03, 28.9; p = 0.003) and Gleason score ≥8 (OR 2.26; 95% CI 0.93, 5.47; p = 0.07) had a higher OR of positive biopsy. Nadir PSA of 0.1 ng/mL or less following salvage cryotherapy is predictive of treatment success. Routine biopsy should be reserved for men with nadir PSA >0.1 ng/mL and patients with high risk features of prostate cancer before salvage cryoablation.