Wednesday, June 29, 2016

Prostate Cancer After Radiotherapy: Initial Results From the Cryo On-Line Data Registry

The outcomes from this observational study indicate that salvage focal cryoablation can be an effective treatment with encouraging potency preservation for patients with locally recurrent PCa after radiotherapy. However, other morbidity including rectoure- thral fistula and incontinence are not clearly lower than for patients treated with salvage whole gland cryoablation. Studies with longer follow-up, more patients, and direct comparison to salvage whole gland cryoablation are needed before recommending salvage focal cryoablation as a standard treatment option for these patients. Prostate 75: 17, 2015. 

Approximately 25% patients with prostate cancer (PCa) undergo radiotherapy as a primary treatment option according to SEER (Surveillance, Epidemiology and End Results) data [1]. Biochemical failure after radiotherapy for localized PCa can occur in approxi- mately 1060% [24]. The most common salvage treatment for these patients is androgen-deprivation therapy [3]. However, this is not a curative treatment. Furthermore, it can have an impact on quality of life and increase the risk of cardiovascular mortality and skeletal fracture [5]. Many patients with biopsy-proven locally recurrent PCa may be suitable for local salvage therapy with curative intent. Local salvage treatment options include radical prostatectomy (RP), cryo- ablation, high-intensity focused ultrasonography, and brachytherapy.
Since salvage RP is limited in clinical practice due to much higher morbidity than primary RP [6], salvage whole gland cryoablation has emerged as an option with acceptable long-term oncological outcomes and lower side effects. However, significant side effects are possible, including urinary retention (3.08.5%), incontinence (4.413.0%), rectourethral fistula (03.3%), and erectile dysfunction (61.5100%) [7,8,9].
In order to decrease complications of salvage cryoablation, several investigators have tried to apply salvage focal cryoablation to small numbers of patients with biopsy-proven unilateral recurrent PCa after radiotherapy. Salvage focal cryoablation of the prostate for locally recurrent PCa after radiotherapy failure was first reported by Eisenberg and Shinohara in 2008 [10]. Several recent publica- tions also showed encouraging outcomes of salvage focal cryoablation for locally recurrent PCa after radiotherapy failure. However, all these studies had small patientsnumbers (the biggest number is 44 patients) [9,11,12].
In this study, we report the outcomes of salvage focal cryoablation at a large number of academic and community centers that have participated in the COLD Registry. To our knowledge, this is the largest data set assembled for salvage focal cryoablation for the treatment of localized PCa recurrence after radio- therapy. 

Ramadan Kareem

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