Locally recurrent prostate cancer after initial radiation therapy: a comparison of salvage radical prostatectomy versus cryother

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J Urol. 2009 Aug;182(2):517-25; discussion 525-7. Epub 2009 Jun 13.

Locally
recurrent prostate cancer after initial radiation therapy: a comparison
of salvage radical prostatectomy versus cryotherapy.
 
Pisters LL, Leibovici D, Blute M, Zincke H, Sebo TJ, Slezak JM, Izawa J, Ward JF, Scott SM, Madsen L, Spiess PE, Leibovich BC.
Department of Urology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

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.