Presented by: Sriram Deivasigamani MBBS
Duke University Medical Center

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 main 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.

Materials

Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome is biochemical progression-free survival (BPFS).  Urinary incontinence, rectourethral fistula, and erectile dysfunction were all secondary outcomes. To compare BPFS rates and identify impacting factors, the Kaplan-Meier log-rank test and Cox proportional hazards models were utilized. Logistic regression analysis (LR) was used to identify factors that predict biochemical recurrence (BCR). 

Results

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419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that were reduced to 63 patients in each cohort after propensity matching. On survival analysis of the propensity-matched cohort, the Kaplan-Meier log-rank test demonstrated no significant difference between groups for BPFS at 2 years (p=0.85) or 5 years (p=0.58). In LR analysis, the BCR rate was higher in the high (OR = 36.38; p=0.03) and intermediate-risk (OR 8.26; p=0.01) D'Amico risk categories compared to low-risk. No differences were noted between groups (CRYO-SCT vs XRT-SCT) in the functional outcomes such as pad-free rates (4.9% vs.16%, p=0.06), erectile function (26% vs.14%, p=0.06), and recto-urethral fistula (5% vs.3%, p=0.3).

Conclusion

Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and  functional outcomes compared to primary radiotherapy. The D'Amico risk group predicts oncologic outcomes, underlining significance of close monitoring after initial therapy in individuals with high or intermediate-risk PCa to detect early recurrence and salvage treatment.

Funding

None

Lead Authors

Scott P. Campbell, MD
Duke University Medical Center

Co-Authors

Rohith Arcot, MD
Duke Medical Center

Eric S. Adams, MD
Duke Medical Center

Hazem Orabi, MD
Assiut University

Ahmed ElShafei, MD
University of Florida Health

Wei Phin Tan, MD
NYU Langone Health

Leah Davis, MS
Duke University Medical Center

Yuan Wu, PHD
Duke University Medical Center

Andrew Chang, MD
Moffit Cancer Center

J Stephen Jones, MD
Inova Health System

Thomas J Polascik, MD, FACS
Duke University Medical Center