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

Scott P Campbell; Sriram Deivasigamani; Rohith Arcot; Eric S Adams; Hazem Orabi; Ahmed Elshafei; Wei Phin Tan; Leah Davis; Yuan Wu; Andrew Chang; J Stephen Jones; Thomas J Polascik

doi:10.1016/j.clgc.2023.06.015

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

Clin Genitourin Cancer. 2023 Oct;21(5):555-562. doi: 10.1016/j.clgc.2023.06.015. Epub 2023 Jun 28.

Authors

Affiliations

¹ Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: scott.p.campbell@duke.edu.
² Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
³ Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Oschner Medical Center, Jefferson, LA.
⁴ Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Urology Department, Assiut University, Assiut, Egypt.
⁵ Department of Urology, University of Florida Health, Jacksonville, FL.
⁶ Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Department of Urology, New York University Medical Center, New York, NY.
⁷ Duke Cancer Institute, Durham NC.
⁸ Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Moffit Cancer Center, Tampa, FL.
⁹ Inova Health System, Falls Church, VA.
¹⁰ Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham NC.

PMID: 37438234
DOI: 10.1016/j.clgc.2023.06.015

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy.

Keywords: Biochemical progression-free survival; Local recurrence prostate cancer; Oncologic outcomes; Salvage cryotherapy.

MeSH terms

Cryosurgery* / methods
Cryotherapy
Disease-Free Survival
Humans
Male
Neoplasm Recurrence, Local / radiotherapy
Neoplasm Recurrence, Local / surgery
Propensity Score
Prostate-Specific Antigen
Prostatic Neoplasms* / radiotherapy
Prostatic Neoplasms* / surgery
Retrospective Studies
Salvage Therapy / methods
Treatment Outcome

Substances

Prostate-Specific Antigen