Androgen deprivation therapy prior to salvage cryotherapy offers minimal benefit

July 1, 2012

Androgen deprivation therapy (ADT) prior to salvage cryoablation appears to improve post-treatment morbidity to some extent but does not affect biochemical-free survival.

Atlanta-Androgen deprivation therapy (ADT) prior to salvage cryoablation appears to improve post-treatment morbidity to some extent but does not affect biochemical-free survival, according to the findings of a recent retrospective analysis.

Speaking at the AUA annual meeting in Atlanta, first author Amy Schlaifer, MD, presented the results of the study that analyzed data from the Cryoablation On-Line Data (COLD) registry. The study included 567 men treated with cryoablation for biopsy-proven locally recurrent prostate cancer following primary treatment with full-dose radiation therapy, of whom 222 had received ADT prior to salvage cryoablation and 345 did not. Men who received ADT after cryoablation were excluded from the analysis.

Using the Phoenix criteria to define biochemical failure, comparisons between the ADT and no-ADT subgroups showed no statistically significant difference (p=.47) in 5-year biochemical-free survival rates for the overall cohorts (41.5% vs. 41.0%, respectively), nor when subdividing the patients into low-risk (p=.27), intermediate-risk (p=.38), and high-risk (p=.87) groups using D'Amico criteria.

"Cryotherapy has become a viable option for men with locally recurrent prostate cancer after radiation therapy, and many of these men will be placed on ADT based on prior information regarding neoadjuvant ADT with radiation therapy and radical prostatectomy. Specifically, in men with high-risk prostate cancer being treated with radiation, prior ADT improves cause-specific and overall survival, and when it is given prior to radical prostatectomy, ADT has been shown to decrease positive margins and early biochemical failure, albeit without any effect at 3 years," said Dr. Schlaifer, a urology resident at Loma Linda University, Loma Linda, CA, working with Herbert Ruckle, MD, and co-authors from multiple institutions.

"We were interested in understanding the impact of ADT prior to salvage treatment of locally recurrent prostate cancer because it is not well defined, but we know that ADT carries risks. Our findings suggest that there are significant risks to consider prior to initiating ADT in patients who chose treatment with salvage cryoablation, as it does not appear to improve biochemical-free survival."

Dr. Schlaifer noted that the study suffers from the limitations of being a retrospective registry review. Of particular note, the only information about ADT related to whether or not it was given.

"Within the COLD registry, there is no information collected regarding the duration of treatment with androgen deprivation prior to salvage cryoablation or what kind of treatment men received. Nevertheless, we believe this is an important study that may help identify patients who may not benefit from preoperative androgen deprivation," she told Urology Times.