Introduction

Outcomes of salvage prostate cryosurgery in older men remain undefined. We evaluated oncological and functional outcomes after salvage full gland prostate cryoablation in men over age 75 years.

Methods

We identified 923 men who underwent salvage full gland prostate cryoablation for recurrent prostate cancer after primary radiotherapy, including 240 (26%) > 75 years at time of surgery. Primary outcomes were progression-free survival (PFS) using Phoenix criteria and post-treatment biopsy status. Secondary outcomes included post-treatment urinary incontinence, erectile dysfunction (ED), rectal fistulae, and urinary retention.

Results

Mean follow-up was 26 months (SD±30). Compared to men ≤ 75 years, men > 75 years were more likely to have pre-treatment Gleason sum ≥7 disease (71% vs.63%, p=0.03) and less likely to have undergone neoadjvuant androgen deprivation therapy (29% vs. 37%, p=0.02) (Table 1). In Kaplan Meir analyses, there were no significant differences in 5-year PFS between groups: 61% versus 57% for men > 75 and ≤ 75 years, respectively (p=0.43) (Figure 1). Post-treatment biopsy was positive in 34% versus 29% of men >75 years and ≤ 75 years, respectively (p=0.5). Older men were more likely to have post-treatment urinary retention (23% versus 15%, p=0.003). There were no significant differences in recto-urethral fistulae (3% versus 2%, p=0.62), urinary incontinence (32% versus 30%, p=0.48), or new onset ED (54% versus 49%, p=0.63) between groups (Table 1).

Conclusions

Salvage whole gland cryoablation of the prostate in men > 75 years is associated with robust progression-free survival and functional outcomes comparable to younger men. Prostate cryoablation should be considered in older men with recurrent disease after primary radiotherapy.

Funding

None