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Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

  • Leonie Exterkate 1,
  • Max Peters 2,
  • Diederik M Somford 1,
  • Henk Vergunst 1
1 Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

Objectives

To evaluate oncological and functional outcomes of salvage cryosurgery (SCS) for radiorecurrent prostate cancer (rrPCa).

Materials and Methods

169 consecutive patients with biopsy‐proven rrPCa were retrospectively analysed. All patients underwent SCS in a single referral centre between 2006‐2018. Primary outcome was biochemical recurrence free survival (BRFS) according to Phoenix criteria (PSA‐nadir +2 ng/mL). Secondary outcomes were overall survival, BRFS defined as PSA >0.5 ng/mL, metastasis free survival, androgen deprivation therapy (ADT) free survival and functional outcomes. Complications were classified according to the Clavien‐Dindo system. PSA was measured every three to six months postoperatively. Functional outcomes were scored as reported by patients at outpatient visits. Kaplan‐Meier survival analysis and uni‐ and multivariable Cox‐regression were performed.

Results

Median follow‐up was 36 months (IQR 18‐66). BRFS after five and eight years was 52% (95%‐CI 43‐62%) and 45% (95%‐CI 35‐57%), respectively. At multivariable analysis PSA at initial diagnosis, initial treatment, interval between primary treatment and SCS, age at SCS, and post‐SCS PSA‐nadir were significant factors for BRFS. Five‐year ADT‐free survival was 70% (95%‐CI 62‐79%). Grade III or more complications occurred in 1.2% (two/169) of patients. 19% (29/156) of patients had new‐onset urinary incontinence defined as >one pad/24h. 92% (57/62) of patients had new‐onset erectile dysfunction. Persistent urinary fistula occurred in 6.5% (11/169) of patients.

Conclusions

This study shows acceptable oncological outcomes of SCS considering the salvage character of the treatment. The occurrence of serious complications such as urinary incontinence and fistula should not be underestimated.