Salvage Cryoablation May Delay the Need for Hormone Therapy in Recurrent Prostate Cancer

Salvage prostate cryoablation may be an effective treatment that can help delay the need for androgen deprivation therapy (ADT) in carefully selected men with locally recurrent prostate cancer, according to a new study presented at the American Urological Association 2018 annual meeting.

Researchers at Fox Chase Cancer Center studied the outcomes of 52 men with nonmetastatic prostate cancer who were initially treated with radiation therapy but later suffered recurrence and received salvage cryoablation. The investigators identified the men from a prospective database of patients undergoing salvage cryoablation after definitive prostate radiation by external beam radiation therapy, brachytherapy, or both. While ADT is the common second-line therapy, these men instead received cryoablation.

“Non-curative-intent salvage prostate therapy following local recurrence after radiation might be a safe way to avoid or delay the initiation of hormone deprivation. If the growing body of evidence regarding the long-term toxicity of androgen deprivation is true, then there is utility in avoiding the need for hormone therapy in selected men whose disease is primarily located in the prostate,” said lead study author Shreyas Joshi, MD, a urologic oncology fellow at Fox Chase Cancer Center, Philadelphia.

In this cohort, the median time between radiation and salvage was 88 months and the median follow-up was 12 months. The researchers found that the median prostate-specific antigen level decline following cryoablation was 96.1%. In addition, 56% (29 men) achieved an undetectable nadir PSA. At last follow-up, 79% (41 men) had not progressed to ADT. In this cohort, 21.2% (11 men) eventually received ADT at a median time to initiation of 9 months following cryoablation.

“PSA kinetics tend to dramatically change, with very few patients experiencing a clinically meaningful rise in PSA. Hence, most will likely never have to go on hormone therapy. I think this highlights the need for proper patient selection when performing salvage therapy,” Dr. Joshi told Cancer Network.

Dr. Joshi said further follow-up is warranted to help better define the extent of response and duration of ADT-free survival following salvage cryoablation therapy in men with locally recurrent disease. Based on these initial findings, salvage cryoablation therapy can really change the clinical course for men who are good candidates for the procedure, according to Dr. Joshi.

“It is hard for this to be standard of care because management of patients in this space is highly variable and based on myriad clinical factors and patient preferences," Dr. Joshi cautioned. “That being said, many presentations were made at AUA 2018 on the topic of salvage cryoablation, and more clinicians will hopefully offer this as an option for patients with locally recurrent prostate cancer who would benefit from avoidance of androgen deprivation.”