Presented by: Sriram Deivasigamani MBBS
Duke University Medical Center

Introduction

Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). Our objectives were to determine intermediate oncological and functional outcomes of patients who underwent SCT after primary brachytherapy (BT-SCT) or cryoablation (CRYO-SCT), as well as the effects of primary therapy on its outcome.

Materials

An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data (COLD) Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- & 5 years post SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function and recto-urethral fistula. Association between treatment and biochemical progression-free survival (BPFS) was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fishers exact test, corrected for IPTW.

Results

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194 patients met inclusion criteria. There was no statistical difference in 2-year BCR (HR 0.9; 95% CI, 0.5–1.7, p=0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p=0.6) between the groups. 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=0.63) or 5 years (p=0.39).The functional outcomes like urinary incontinence (p=0.4), erectile function (p=0.1) and recto-urethral fistula (p=0.3) were not statistically different.

Conclusion

CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary brachytherapy. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial cryotherapy with minimal morbidity. 

Funding

None

Lead Authors

Hazem Orabi, MD
Assiut University

Co-Authors

Ahmed El-Shafei, MD
University of Florida Health

Eric S Adams, MD
DUKE UNIVERSITY MEDICAL CENTER

Srinath Kotamarti, MD
Duke University Medical Center

Ali Aminsharifi, MD
Penn State Health Mission S.Hershey Medical Center

Leah Davis, MD
Duke University Medical Center

Yuan Wu, MD
Duke University Medical Center

J Stephen Jones, MD
Inova Health System

Thomas J. Polascik, MD
Duke University Medical Center