Partial salvage cryoablation of the prostate for local recurrent prostate cancer after primary radiotherapy: Step-by-step technique and outcomes

Purpose: To describe the technique as well as the oncological and functional outcomes of partial salvage prostatic cryoablation (SCAP) in the treatment of local recurrent prostate cancer after primary radiotherapy. Materials and methods: The indications for partial SCAP were: PSA10 years and PSA doubling time >12 months. Cryoablation was performed with the Precise© device (Galil MedicalⓇ, Arden Hills, Minnesota, USA). Results: Fourteen patients underwent partial SCAP from 09/2010 to 09/2018. Primary treatment consisted of: 29% brachytherapy and 71% EBRT with concomitant androgen deprivation therapy (ADT) in 50%. Median time to recurrence was 8.5 years [3.2–19.3]. At the time of cryotherapy, median age was 72 years [58–84], Charlson was 3 [1–6] and serum PSA was 4.2 [2.2–9.0]. Mean procedure time was 90 min [60–120]. Median hospital stay and catheter duration were respectively 2 days [2–6] and 8 days [3–14]. Median biochemical disease-free survival was 4.4 years and 71% of the patients were free of third-line treatment at the time of evaluation. No patient developed metastasis, and all were alive at the time of the last evaluation. De novo urinary incontinence was reported in one patient and de novo erectile dysfunction in one patient. Conclusions: Partial SCAP was an alternative to salvage prostatectomy and whole gland ablation for highly selected patients with locally recurrent PCa after radiotherapy. It significantly avoided or at least delayed the need for ADT.