Abstract: PD56-02
Sources of Funding: Healthtronics

Introduction

Success of salvage cryoablation (SCAP) for radiorecurrent prostate cancer is typically measured by the ability to control serum PSA. However, slight elevations in PSA are typically asymptomatic and likely unimportant especially considering that most SCAP patients have a limited life expectancy based on comorbidities and advancing age. We propose that a more clinically meaningful endpoint would be the ability of SCAP to avoid the need for androgen deprivation therapy (ADT). Using the Cryo On-Line Database (COLD) registry, we investigated the ability of SCAP to delay or avoid ADT in local recurrence after radiation therapy.

Methods

The COLD registry is comprised of retrospectively and prospectively collected data on patients undergoing primary and SCAP. Patients with local recurrence after curative radiation to the prostate were identified. Kaplan-Meier analysis was used to calculate ADT-free survival.

Results

998 patients were identified in the COLD database that had undergone SCAP. Median follow up was 19 months. 171 (17.1%) had been started on ADT post-SCAP. Overall, the calculated 5-year ADT-free survival was 71.7%(Figure 1). When stratified by D&[prime]Amico risk group, 301 high-risk patients (74.5%), 263 intermediate-risk (88.0%) and 261 low-risk (89.1%) were free of ADT post-SCAP. This correlates with a 5-year ADT-free survival of 61.2%, 74.3%, and 82.7%, respectively (Figure 2). Preoperative ADT use or full vs. partial gland SCAP did not have an effect on ADT use postoperatively. Of 213 patients with recurrence based on serum PSA elevations (Phoenix definition), ADT was avoided in 118 (55%).

Conclusions

For the patient with local recurrence after radiation, SCAP is an option that provides a high chance of avoiding ADT. The potential to avoid ADT and its associated side effects should be a part of counseling sessions between the patient, family, and urologist when discussing treatment options for locally radiorecurrent prostate cancer. Avoidance of ADT is more clinically relevant endpoint than biochemical recurrence.

Funding

Healthtronics