Predicting the side effects and prognosis following salvage cryotherapy in patients with prostate cancer that has returned after radiotherapy

This study examined whether it is possible to predict side effects and prognosis following salvage cryotherapy in patients with prostate cancer.

Salvage therapy is a form of treatment given after a cancer does not respond or returns after a main treatment. More than 30% of prostate cancer patients develop a recurrence (return of the cancer) following radiotherapy. Salvage radical prostatectomy or RP (the removal of the cancer along with the whole prostate gland) following radiation treatments is more difficult than surgery as the main treatment, due to the changes radiation can cause in the prostate and surrounding tissues. A salvage RP can lead to effects such as bowel injury and loss of bladder control (urinary incontinence). While salvage RP is currently thought to offer the best chance of a cure for young patients, a new treatment, salvage cryotherapy (SCT), has also been developed. SCT uses extremely cold temperatures to freeze and kill cancer cells, leaving behind an “iceball”. This treatment can also lead to side effects such as urinary or sexual problems. The current study explores whether it is possible to predict side effects and prognosis following SCT in patients with prostate cancer.

This study included 283 patients with prostate cancer that has recurred after radiotherapy. All patients were treated with SCT and followed up for 6 years after this procedure. The main parameters measured were cancer recurrence and disease-free survival or DFS (the percentage of patients with no signs of prostate cancer for a defined period after treatment) which were evaluated through the level of the prostate-specific antigen or PSA (a protein made by the prostate gland whose levels rise in prostate cancer) in the blood. Researchers also evaluated side effects and quality of life of the participants.

Results showed that PSA levels were strongly associated with DFS following SCT. If PSA levels were 1 ng/ml or lower, the 12- and 36-month DFS rates were 84% and 67%, respectively. For patients with a PSA level greater than 1 ng/ml following SCT, DFS rates were 56% at 12 months, and 14% at 36 months. The authors of the study found that up to 36% of patients experienced urinary incontinence after the SCT, with 12% persisting more than 6 months after the treatment. Worse side effects were associated with a larger prostate gland and a larger size of the iceball generated by the SCT.

In summary, SCT is an effective treatment option for patients whose cancer has returned after radiotherapy and the PSA level is a good predictor of patients' outcomes. However, SCT also exposes patients to certain side effects which are directly related to the size of the prostate gland and the area of the SCT treatment. 

This study included patients that have been treated in the past (retrospective study), therefore the data included is based only on hospital records only. Retrospective studies are considered to provide weaker statistical information.

Talk to your doctor whether SCT is appropriate in your situation.