Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis

Sriram Deivasigamani; Hazem Orabi; Ahmed El-Shafei; Eric S Adams; Srinath Kotamarti; Ali Aminsharifi; Leah Davis; Yuan Wu; Stephen Jones J; Thomas J Polascik

doi:10.1002/pros.24600

Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis

Prostate. 2023 Oct;83(14):1373-1386. doi: 10.1002/pros.24600. Epub 2023 Jul 19.

Authors

Sriram Deivasigamani¹, Hazem Orabi^{1

2}, Ahmed El-Shafei³, Eric S Adams¹, Srinath Kotamarti¹, Ali Aminsharifi^{1

4}, Leah Davis¹, Yuan Wu⁵, Stephen Jones J⁶, Thomas J Polascik¹

Affiliations

¹ Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA.
² Urology Department, Assiut University, Assiut, Egypt.
³ Department of Urology, University of Florida Health, Jacksonville, Florida, USA.
⁴ Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
⁵ Duke Cancer Institute and Department of Statistics, Durham, North Carolina, USA.
⁶ Inova Health System, Falls Church, Virginia, USA.

PMID: 37469120
DOI: 10.1002/pros.24600

Abstract

Background: Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT).

Methods: An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 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 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 Fisher's exact test, corrected for IPTW.

Results: A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [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. The functional outcomes like urinary continence (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 BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.

Keywords: biochemical recurrence; brachytherapy; cryotherapy; functional outcomes; oncological outcomes; prostate cancer; salvage therapy.

MeSH terms

Brachytherapy* / adverse effects
Cryotherapy / adverse effects
Erectile Dysfunction* / etiology
Fistula* / etiology
Fistula* / therapy
Humans
Male
Neoplasm Recurrence, Local / radiotherapy
Neoplasm Recurrence, Local / surgery
Propensity Score
Prostate-Specific Antigen
Prostatic Neoplasms* / radiotherapy
Prostatic Neoplasms* / surgery
Retrospective Studies
Salvage Therapy
Treatment Outcome

Substances

Prostate-Specific Antigen