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Comparative Study
. 2024 Sep 11;42(1):515.
doi: 10.1007/s00345-024-05199-4.

Cryotherapy versus radical prostatectomy as a salvage treatment for radio-recurrent prostate cancer

Juan Gomez Rivas #  1 , Mark Taratkin #  2 , Camilla Azilgareeva  2 , Andrey Morozov  2 , Silvia Laso  1 , Dmitry Enikeev  2   3   4   5 , Jesús Moreno Sierra  1 , Ksenia Schelkunova  6 , Francesco Sanguedolce  7 , Alberto Breda  7 , Alexander Govorov  8 , Alexander Vasilyev  8 , Marcos Cepeda  9 , Lukas Lusuardi  10 , Maximilian Pallauf  10 , Antonio Celia  11 , Tommaso Silvestri  11 , Cristian Fiori  12 , Esaú Fernández  13 , Juan Ignacio Martínez-Salamanca  13 , Eric Barret  14
Affiliations
Comparative Study

Cryotherapy versus radical prostatectomy as a salvage treatment for radio-recurrent prostate cancer

Juan Gomez Rivas et al. World J Urol. .

Abstract

Introduction: The aim of this study is to compare outcomes of SRP (salvage radical prostatectomy) with SCAP (salvage cryoablation of the prostate) in local radio-recurrent PCa (prostate cancer) patients.

Materials and methods: A retrospective analysis of a multicentric European Society of Uro-technology (ESUT) database was performed. Data on patients with local recurrent PCa after radiotherapy who underwent salvage treatment were collected. Patients and their respective disease characteristics, perioperative complications as well as oncological outcomes were then described. The treatment success rate was defined as PSA nadir < 0,4 ng/ml. Any complications were graded according to the modified Clavien system. A descriptive and comparative analysis was performed using SPSS software.

Results: 25 patients underwent SRP and 71 patients received SCAP. The mean follow-up was 24 months. The median PSA level before initial treatment was 8.3 (range 7-127) ng/ml. The success rates of SRP and SCAP were largely comparable (88% (22 patients) vs. 67.7% (48 patients), respectively, p = 0.216). The mean serum PSA levels at 12 months after salvage treatment were 1.2 ± 0.2 ng/mL vs. 0.25 ± 0.5 ng/mL, p > 0.05). During the follow-up period, only 3 (12%) patients in the SRP group had PSA recurrence compared with 21 patients (29.6%) in the SCAP group. The 5-year BRFS was similar (51,6% and 48,2%, p = 0,08) for SRP and SCAP respectively. The 5-year overall survival rate was 91.7%, and 89,7% (p = 0.669) and the 5-year cancer-specific survival was 91.7%, and 97,1% (p = 0.077), after SRP and SCAP respectively. No difference was found regarding the complications.

Conclusions: Both SRP and SCAP should be considered as valid treatment options for patients with local recurrence of PCa after radiotherapy. SCAP has a potentially lower risk of morbidity and acceptable intermediate-term oncological efficacy, but a longer follow up and a higher number of patients is ideally needed to draw any long-term conclusions regarding the oncological data.

Keywords: Cryoablation; Prostate cancer; Radiation therapy; Radical prostatectomy; Salvage surgery.

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References

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