(Spiess et al. 2006)
Design: Retrospective case series (therapy), evidence level: 3
Country: United States, setting: Tertiary care
Inclusion criteria Men treated with cryotherapy for recurrent prostate cancer at a single institution between 1980 and 2004. Primary treatment was EBRT in all cases.
Exclusion criteria Neoadjuvant or adjuvant hormonal therapy with cryotherapy. A minimum of 3 PSA measurements before and after cryotherapy.
Population number of patients = 49, age range 58 to 81 years, median age = 66 years.
Interventions Men were treated with salvage cryotherapy (not described in detail)
Outcomes Overall survival, disease specific survival, clinical recurrence and biochemical recurrence (increasing PSA, at least 2 ng/mL above the postsalvage nadir).
Follow up Median follow-up was 5.7 years
Results 26/49 men (53%) experienced biochemical failure. 11/49 men (22%) experienced distant metastases. 18/49 men (37%) died from prostate cancer, after a median disease specific survival duration of 9.4 years (range 7.8 to 12.6 years). Overall mortality was 20/49 (41%).
On multivariate analysis of prognostic factors for biochemical failure free survival, pre-salvage PSA-DT <16 months was an adverse prognostic factor (RR = 0.43, p=0.06) and pre-salvage serum PSA > 10 ng/ml was a favourable prognostic factor (RR=1.12, p=0.002).
General comments Series spans two decades, cryotherapy technique is likely to have changed substantially.

From: Chapter 5 –The Management of Relapse After Radical Treatment

Cover of Prostate Cancer
Prostate Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 58.
National Collaborating Centre for Cancer (UK).
Copyright © 2008, National Collaborating Centre for Cancer.

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