Background:
We wish to assess the incidence and the pattern of local recurrence of prostate cancer following radiation therapy administered with curative intent. This is an updated analysis of our experience on 178 salvage cryoablation patients to gain further insight into the role and techniques of salvage cryoablation.
Methods:
Amongst 178 patients from 1995 to 2003, we selected 117 patients with longer follow-up (median 56 months). All patients had biopsy-proven local recurrence following radiotherapy and had a negative metastatic work-up. Three dimensional ultrasound (3D US)-guided cryoablation was performed with 2 freeze/thaw cycles.
Results:
Median PSA pre-cryoablation was 6.2 ng/ml. Serial serum prostate specific antigen (PSA) levels were done at 3, 6, 12, 24, and 36 months post-operative and repeat biopsy at 6, 12, and 24 months whenever logistically feasible. Four quadrant biopsy was performed with additional cores taken from suspicious areas. Results of 27 patients (23.1%) had biopsies positive for prostate cancer with 1-3 cores being positive. Grading distribution was 27.3% Gleason < 6; 72.3% >7. Location of recurrence involved the apex in 17/27 (11/17 had apex only). The base was involved in 7/27 (3/7 had base only). Seminal vesicles 5/27; midportion only 1 patient. Overall 5-year biochemical recurrence-free rate was 28%, although those with recurrence at the base all had biochemical recurrence.
Conclusions:
Salvage cryoablation in patients with radiation failure was a viable treatment option achieving local control in over 75% of patients at 5 years and 28% biochemical control. The location for local failure was mainly at locations where under-treatment may be due to concern for possible complications. Local recurrence at the base likely was the result of more extensive cancer and had a poorer prognosis. Modification of cryo techniques and better patient selection may further improve the results of cryoablation.

Back to Final Program