Prostate Institute of America

e15212 Background: Salvage cryoablation (SC) of the whole prostate is a curative option for radio (RT)-recurrent prostate cancer (PCa). Focal SC has emerged as an option for minimizing morbidity. We present our 7-year experience of oncological and functional outcomes of Salvage Focal (SFC) and Salvage Total (STC) Cryoablation (CRYO) for RT-recurrent PCa. Methods: From Dec 2003 to Aug 2010, 50 men underwent SFC (n=25) or STC (n=25) for RT-recurrent PCa. SFC patients had biopsy-proven unilateral PCa and underwent a hemi-CRYO of the prostate. STC patients underwent CRYO of the whole prostate gland. All patients were evaluated to exclude metastases prior to treatment. Two freeze-thaw cycles were used to perform transperineal prostate CRYO under TRUS guidance. Follow up was assessed by PSA, TRUS, biopsy and questionnaires at 3, 6, 12, 24 and 36 mth. Results: Median (range) age, PSA and Gleason score for the SFC group were 71 y (59-81); 2.8 ng/ml (0-8.2) and 7 (6-8), while those for STC were 73 y (57-83), 3.9 ng/ml (0.1-12) and 7 (6-9), respectively. Oncological outcomes: Within one year after SC, the median percent PSA-decrease was 89% for SFC and 98% for STC. The median (range) follow up was 31 mth (4-90) for SFC and 53 mth (12-92) for STC. No patient died. One patient treated with STC developed bone metastases. Using the Phoenix criteria (PSA nadir + 2 ng/ml), 8 SFC and 3 STC patients had biochemical failure (BF), and the 5-year biochemical free survival (BFS) was 54% and 86% respectively (p=0.05). In those patients with no BF, the median PSA remained stable, ranging from 0.2 to 0.6 ng/ml for SFC and 0.1 to 0.1 ng/ml for STC during the follow up period. Follow up biopsy-proven cancer occurred in 2 patients in the SFC group (both on the untreated side), and in 1 patient in the STC group. Functional outcomes: New onset urinary incontinence occurred in none (0) of the SFC vs 3 (13%) of the STC patients. One (4%) patient in the STC group developed a recto-urethral fistula. Conclusions: Salvage Focal and Total CRYO after RT-failure are feasible and safe. Although STC had a favorable BFS compared with SFC, there was no significant difference in disease specific or overall survival between groups. SFC offered comparable cancer control to STC with lower morbidity.

Numerous studies on prostatic disease have been performed at Veterans Affairs (VA) Medical Centers. Recent investigations evaluating early detection of prostate cancer provide insight that the average prostate volume may be different between patients with similar clinical findings who are from different hospital settings. The objective of this study was to compare prostate size between men from University and VA Medical Centers. Patients were enrolled retrospectively from 1989-1996 from the Urology Clinics at a University and a VA Medical Center. All men underwent transrectal ultrasound-guided sextant biopsy of the prostate owing to either an elevated prostate-specific antigen (PSA) level and/or abnormal digital rectal examination (DRE) detected prior to biopsy. Prostate volume was calculated using the ellipsoid three-diameter formula based on transrectal ultrasound measurements. There were 1,311 men included in the analysis: 717 were from the VA, and 594 were from the University. The average prostate volume was significantly smaller among VA patients both for men with cancer (P = 0.0004) and for men with no evidence of malignancy (P < 0.0001). Overall, the average prostate volume was 38.5 cm3 (median, 32.5 cm3) among men from the VA compared to 46.8 cm3 (median, 39.3 cm3) among men from the University Medical Center. Men from the VA were older (mean +/- SD = 68 +/- 7.3) than men from the University (mean +/- SD = 66 +/- 7.7) (P = 0.004) and there was no significant difference in PSA levels between the two groups of patients (P = 0.11). Intriguingly, the incidence of cancer was significantly lower at the VA (24.5%) compared to the University (35.9%) (P < 0.0001). The variance in prostate size suggests that there are significant differences between the two patient populations. Proposed factors leading to this discrepancy include differences in socioeconomic factors, environmental factors, and changes in hormonal milieu related to alcohol and tobacco use. These results may have significant implications regarding the interpretation and extrapolation of results from previous studies performed at a single hospital setting.