Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy
Abstract
Purpose:
We compared the treatment outcomes of salvage radical prostatectomy and salvage cryotherapy for patients with locally recurrent prostate cancer after initial radiation therapy.
Materials and Methods:
We retrospectively reviewed the medical records of patients who underwent salvage radical prostatectomy at the Mayo Clinic between 1990 and 1999, and those who underwent salvage cryotherapy at M. D. Anderson Cancer Center between 1992 and 1995. Eligibility criteria were prostate specific antigen less than 10 ng/ml, post-radiation therapy biopsy showing Gleason score 8 or less and prior radiation therapy alone without pre-salvage or post-salvage hormonal therapy. We assessed the rates of biochemical disease-free survival, disease specific survival and overall survival in each group. Biochemical failure was assessed using the 2 definitions of 1) prostate specific antigen greater than 0.4 ng/ml and 2) 2 increases above the nadir prostate specific antigen.
Results:
Mean followup was 7.8 years for the salvage radical prostatectomy group and 5.5 years for the salvage cryotherapy group. Compared to salvage cryotherapy, salvage radical prostatectomy resulted in superior biochemical disease-free survival by both definitions of biochemical failure (prostate specific antigen greater than 0.4 ng/ml, salvage cryotherapy 21% vs salvage radical prostatectomy 61% at 5 years, p <0.001; 2 increases above nadir with salvage cryotherapy 42% vs salvage radical prostatectomy 66% at 5 years, p = 0.002) and in superior overall survival (at 5 years salvage cryotherapy 85% vs salvage radical prostatectomy 95%, p = 0.001). There was no significant difference in disease specific survival (at 5 years salvage cryotherapy 96% vs salvage radical prostatectomy 98%, p = 0.283). After adjusting for post-radiation therapy biopsy Gleason sum and pre-salvage treatment serum prostate specific antigen on multivariate analysis salvage radical prostatectomy remained superior to salvage cryotherapy for the end points of any increase in prostate specific antigen greater than 0.4 ng/ml (HR 0.24, p <0.0001), 2 increases in prostate specific antigen (HR 0.47, p = 0.02) and overall survival (HR 0.21, p = 0.01).
Conclusions:
Young, healthy patients with recurrent prostate cancer after radiation therapy should consider salvage radical prostatectomy as it offers superior biochemical disease-free survival and may potentially offer the best chance of cure.
References
- 1 : Prostate specific antigen doubling time and disease relapse after radiotherapy for prostate cancer. Cancer1994; 74: 670. Crossref, Medline, Google Scholar
- 2 : Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: clinical observations. J Clin Oncol1997; 15: 230. Google Scholar
- 3 : Prostate specific antigen only progression of prostate cancer. J Urol2000; 163: 1632. Link, Google Scholar
- 4 : Deoxyribonucleic acid ploidy and serum prostate specific antigen predict outcome following salvage prostatectomy for radiation refractory prostate cancer. J Urol1999; 161: 857. Link, Google Scholar
- 5 : Salvage cryotherapy for recurrent prostate cancer after radiotherapy: variables affecting patient outcome. J Clin Oncol2002; 20: 2664. Google Scholar
- 6 : Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer. J Urol1995; 154: 1103. Link, Google Scholar
- 7 : The efficacy and complications of salvage cryotherapy of the prostate. J Urol1997; 157: 921. Link, Google Scholar
- 8 : Patient selection for salvage cryotherapy for locally recurrent prostate cancer after radiation therapy. J Clin Oncol1999; 17: 2514. Google Scholar
- 9 : Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point?. J Urol2001; 165: 1146. Link, Google Scholar
- 10 : Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology1999; 53: 2. Google Scholar
- 11 : A feasibility study of cryotherapy followed by radical prostatectomy for locally advanced prostate cancer. J Urol1999; 161: 509. Link, Google Scholar
- 12 : Proximity of prostate cancer to the urethra: implications for minimally invasive ablative therapies. Urology2000; 56: 726. Google Scholar
- 13 : Incomplete glandular ablation after salvage cryotherapy for recurrent prostate cancer after radiotherapy. Int J Radiat Oncol Biol Phys2003; 56: 468. Google Scholar
- 14 :
Cryotherapy of prostate cancer . In: Campbell-Walsh Urology. Edited by . Philadelphia: Elsevier2007: 3033. chapt 101. Google Scholar - 15 : Salvage prostate cryoablation: initial results from the Cryo On-Line Data Registry. J Urol2008; 180: 559. Link, Google Scholar
- 16 : Salvage cryoablation of the prostate: followup and analysis of predictive factors for outcome. J Urol2007; 178: 1253. Link, Google Scholar
