Salvage Ablation for Locally Recurrent Prostate Cancer

Derek J. Lomas; David A. Woodrum; Lance A. Mynderse

Disclosures

Curr Opin Urol. 2021;31(3):188-193. 

In This Article

Adverse Effects

Although salvage cryotherapy is less invasive compared to radical prostatectomy, adverse effects can still be significant. Valle et al. reported that the rates of severe (Clavien 3 or higher) genitourinary and gastrointestinal toxicity were 15 and 1.7%, respectively.[3] Ingrosso et al. reported a pooled-prevalence of incontinence of 15%. Other adverse effects reported included obstruction (5%), recto-urethral fistula (1%), perineal pain (8%), and erectile dysfunction (37%).[15]

Bain et al. reported an overall complication rate of 27%.[10] In a predominantly whole gland salvage cryotherapy series, bladder neck contracture/stricture rates ranged from 6 to 10.8%.[10,13,14] Rectourethral fistula rates ranged from 2 to 6%.[12–14] New incontinence requiring one pad per day (PPD) was reported in two studies and ranged from 19 to 25.3%,[12,14] whereas the rate of two PPD incontinence was 3% in another.[13] Erectile dysfunction was reported in one study and was 92%.[12]

In the MRI guided focal cryotherapy series the rate of severe incontinence (several PPD) was 3.2% at 1 year.[11] Incontinence and erectile function questionnaires indicated worsening of both; however, there were no significant quality of life changes. Fistula occurred in three (4.8%) patients all of who were managed conservatively and one (1.6%) patient developed a urethral stricture.

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