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Outcomes of salvage prostate cryotherapy stratified by pre-treatment PSA: update from the COLD registry

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Abstract

Objectives

In this study, we evaluate the outcomes of salvage cryotherapy for locally recurrent prostate cancer within the COLD (cryo online data) Registry. Furthermore, we assess the results of salvage cryotherapy (with intermediate follow-up) stratified by pre-treatment prostate-specific antigen (PSA) levels to determine which patients may best be suited for treatment.

Methods

The COLD registry was developed as a prospective, centrally collected database among patients undergoing salvage cryoablation for locally recurrent prostate cancer following primary prostate radiotherapy with curative intent. Of the patients undergoing salvage cryotherapy (without neoadjuvant hormonal ablative therapy), complete medical records were available in 156 patients, with their mean follow-up being 3.8 years (0.9–12.7 years). The treatment outcomes of salvage cryotherapy were assessed using the Phoenix definition (nadir PSA + 2 ng/ml) of biochemical failure.

Results

Of our entire study population, the biochemical disease-free survival (bDFS) rates at 1, 2, and 3 years were 89.0, 73.7, and 66.7 %, respectively. Stratification of our patients into two subgroups is based on their pre-treatment total serum PSA values <5 and ≥5 ng/ml, and bDFS rates at 3 years for these two subgroups were 78.3 and 52.9 %, respectively. A Kaplan–Meier analysis of bDFS stratified by these same pre-treatment PSA values revealed that the subset of patients with a PSA ≥ 5 ng/ml had statistically significant poorer bDFS rates (P = 0.01).

Conclusions

Salvage prostate cryotherapy is a potentially curative local salvage therapy. The importance of early referral when patients have a pre-treatment PSA < 5 ng/ml is essential to optimize treatment outcomes.

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Conflict of interest

All of the authors have contributed to this manuscript in a meaningful scientific manner and have approved the final submitted version. All authors are paid consultants and advisory board members of the COLD registry; however, the data reported have been collected and analyzed by an independent research company (Watermark Research Partners©; Indianapolis, IN, USA). Drs. Spiess, Levy, Pisters, Mouraviev, and Jones are all paid consultants to Endo Pharmaceuticals.

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Authors and Affiliations

  1. Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Office 12538, Tampa, FL, 33612, USA

    Philippe E. Spiess

  2. Department of Regional Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    David A. Levy & J. Stephen Jones

  3. Department of Urologic Oncology, Anderson Cancer Center, Houston, TX, USA

    Louis L. Pisters

  4. Department of Urology, University of Cincinnati, Cincinnati, OH, USA

    Vladimir Mouraviev

Authors
  1. Philippe E. Spiess
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  2. David A. Levy
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  3. Louis L. Pisters
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  4. Vladimir Mouraviev
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  5. J. Stephen Jones
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Corresponding author

Correspondence to Philippe E. Spiess.

Additional information

The COLD registry is sponsored by an unrestricted research grant from Endo Pharmaceuticals©. Data are held and analyzed by Watermark, an independent research company under the direction of an independent physician board.

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Spiess, P.E., Levy, D.A., Pisters, L.L. et al. Outcomes of salvage prostate cryotherapy stratified by pre-treatment PSA: update from the COLD registry. World J Urol 31, 1321–1325 (2013). https://doi.org/10.1007/s00345-012-0982-2

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  • DOI: https://doi.org/10.1007/s00345-012-0982-2

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