At the 17th International European Association of Urology Meeting, Joseph Chin of the University of Western Ontario presented his analysis of outcomes of 157 patients treated with whole-gland salvage cryotherapy after primary radiotherapy failure between 1995 and 2004. After a median followup of 117 months:
- · 10-year overall survival was 76%
- · 10-year metastasis-free survival was 74%.
- · Median biochemical disease-free survival was 56 months.
- · 10-year biochemical disease-free survival was 34%.
- · 15-year biochemical disease-free survival was 23%.
- · Of the 179 complications, 22 (12%) were serious.
While more than 3 in 4 men had a biochemical recurrence after salvage cryotherapy, it’s not at all clear whether any salvage therapy on this group of patients could have increased survival any better or with fewer complications. As far as I’m aware, this is the longest followup that has been reported in a salvage cryotherapy study, but, paradoxically, its greatest strength is also its greatest weakness. Many of the men treated in this study were selected for salvage treatment before we had advanced imaging techniques that might have identified small distant metastases in many of them. Also, cryotherapy has benefitted from technological advances that have reduced morbidity considerably.
There are many outstanding questions:
- · How should patients be selected for salvage therapy after radiation?
- · Can we use advanced imaging to eliminate those patients in whom distant metastases have already occurred?
- · Did the salvage therapy delay progression?
- · Is there a survival advantage to salvage whole-gland cryoablation vs. focal or hemi-gland cryoablation?
- · Is there an advantage in terms of treatment morbidity to salvage whole-gland cryoablation vs. focal or hemi-gland cryoablation?
- · How does salvage cryo compare to other ablative salvage therapies, salvage radiotherapies, or salvage surgery after radiation failure?