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Long-term outcomes of two ablation techniques for treatment of radio-recurrent prostate cancer

Prostate Cancer and Prostatic Diseases volume 24, pages 186–192 (2021)Cite this article

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Abstract

Background

In men with recurrence of prostate cancer post radiation therapy, further treatment remains a challenge. The default salvage option of androgen-deprivation therapy (ADT) has adverse effects. Alternatively, selected men may be offered salvage therapy to the prostate. Herein, we present long-term oncological outcomes of two whole-gland ablation techniques, cryotherapy (sCT) and high-intensity-focused ultrasound (sHIFU).

Methods

Men undergoing sCT (1995–2004) and sHIFU (2006–2018) at Western University were identified. Oncological endpoints included biochemical recurrence (BCR), ADT initiation, metastases, castration resistance (CRPC), and prostate cancer-specific mortality (PCSM). Survival analysis with competing risks of mortality was performed. Multivariable analysis was performed using Fine and Gray regression.

Results

A total of 187 men underwent sCT and 113 sHIFU. Mean (SD) age of the entire cohort was 69.9 (5.9 years), median pre-radiation PSA 9.6 ng/ml (IQR 6.1–15.2), and pre-salvage PSA 4.5 ng/ml (IQR 2.8–7.0). Median total follow-up was 116 months (IQR 67.5–173.8). A total of 170 (57.6%) developed BCR, 68 (23.4%) metastases, 143 (49.3%) were started on ADT, 58 (20.1%) developed CRPC, and 162 (56%) patients died of which 59 (36.4%) were of prostate cancer. On multivariable analysis, sHIFU (HR 1.65, 95% CI 1.15–2.36, p = 0.006) and pre-salvage PSA (HR 1.09, 95% CI 1.06–1.13, p < 0.0001) were associated with a higher risk of BCR. Similarly, sHIFU patients had a higher risk of CRPC (HR 2.31, 95% CI 1.23–4.35, p = 0.009). The cumulative incidence (for both treatments) of PCSM was 16.5% (95% CI 12.2–21.4%) at 10 years and 28.4% (95% CI 22.1–34.9%) at 20 years, with no difference between treatment modalities. Pre-salvage PSA was a common predictor for the measured oncological outcomes.

Conclusions

Although sHIFU had higher BCR and CRPC rates, there were no differences in PCSM when compared with sCT. The long-term oncological data on two ablation techniques highlighted that only 50% of patients started ADT after 10-year follow-up.

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Fig. 1: Cumulative incidences of oncological parameters for the two ablation techniques.

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Authors and Affiliations

  1. Departments of Urology and Oncology, Western University, London, ON, Canada

    Shiva M. Nair, Arnon Lavi & Joseph L. Chin

  2. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands

    Max Peters, Piet Kurver, Joost J. C. Verhoeff, Jochem R. N. van der Voort van Zyp & Marieke J. van Son

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  1. Shiva M. Nair
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Correspondence to Joseph L. Chin.

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Nair, S.M., Peters, M., Kurver, P. et al. Long-term outcomes of two ablation techniques for treatment of radio-recurrent prostate cancer. Prostate Cancer Prostatic Dis 24, 186–192 (2021). https://doi.org/10.1038/s41391-020-00265-5

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