Abstract: PD56-01
Sources of Funding: None

Introduction

There is a paucity of long-term data following local recurrences from radiation refractory prostate cancer (RRPCa). We analyzed the long-term survival outcomes of salvage cryoablation (Cryo) for RRPCa cancer across two centers.

Methods

Patients undergoing salvage Cryo for biopsy proven, localized RRPCa from 1990 to 2004 were prospectively accrued. Preoperative characteristics, perioperative morbidity and postoperative data were reviewed from a prospectively maintained database. The primary outcome was overall survival (OS). Secondary outcomes were metastasis-free survival (MFS) and disease specific survival (DSS).

Results

268 patients were identified with a median follow up of 115 months (55.25-151 IQR). Median age is 70 yrs. (65.8-73 IQR). Median PSA nadir was 2 (1-4.25 IQR) and median pre-salvage PSA was 6 (3.5-10.4 IQR). 20% (54/268) had Gleason score <7 at time of recurrence, 10% (28/268) had a Gleason score of 7, and 69% (184/268) had Gleason score >7. Out of 268 patients, 15 (5.6%) underwent repeat cryotherapy and neoadjuvant hormones were used in 29% of patients (77/268). _x000D_ Of the 268 patients, 123 (45%) experienced some form of morbidity. 101 (38%) had mild-moderate incontinence (0-1 pad/day), 43 (16%) had severe incontinence (≥2 pad/day), 43 (16%) experienced pelvic/perineal pain, 4 (1.5%) had rectourethral fistula, 68 (25%) had urinary retention, 38 (14%) had gross hematuria, and 28 (10.4%) had a bladder neck contracture, 12 (4.4) had urethral stricture disease. There were 176 Clavien 1-2, and 48 Clavien 3 events in the cohort. 4 (1.4%) patients were SP tube dependent and 3 (1.1%) patients went on to cystoprostatectomy.48% (130/268) of patients died by study follow up, 22% (59/268) died of RRPCa, and 31% (84/268) developed metastasis. Median OS was 163 mo., DSS 210 mo. and MFS was 199 mo. There was a significantly worse OS (p=0.027) and MFS (p=0.0114) for patients with a pre-cryotherapy PSA > 10 than those with a PSA <5, and those with PSA 5-10 – Figure 1. _x000D_

Conclusions

Cryo for RRPCa provides long term MFS, DSS and OS with an acceptable degree of morbidity and is a viable treatment option of localized RRPCa following radiation therapy. Pre-Cryo PSA appears to serve as a prognostic tool for patient selection, and further prospective trials are required for validation.

Funding

None