Achieving the 'bifecta' using salvage cryotherapy for locally recurrent prostate cancer: analysis of the Cryo On-Line Data (COLD) Registry data

OBJECTIVES To evaluate the contemporary outcomes of salvage cryotherapy for locally recurrent prostate cancer using the Cryo On-Line Data (COLD) Registry. We also evaluate the outcomes of salvage cryotherapy in achieving the therapeutic 'bifecta' consisting of: (i) achieving a post-cryotherapy nadir serum PSA level of <0.6 ng/mL and (ii) no urinary incontinence. PATIENTS AND METHODS A prospectively, centrally collected secure online database has been developed of patients undergoing salvage cryoablation for locally recurrent prostate cancer. Of the patients undergoing salvage cryotherapy (in the absence of neoadjuvant hormonal ablative therapy) included within the COLD Registry, complete medical records pertaining to continence status and serial PSA measurements after treatment were available in 183 patients. RESULTS The therapeutic 'bifecta' was achieved in 133 of these patients (72.7%). Of the patients achieving the 'bifecta', the mean (sd) age at presentation was 71.5 (6.6) years. Most patients (91%) had a baseline pre-salvage total serum PSA level of <10 ng/mL and a pre-treatment biopsy Gleason score of <8 (85%). The mean duration of follow-up of patients achieving the 'bifecta' was 36.5 months. CONCLUSIONS The therapeutic 'bifecta', a new surrogate benchmark for salvage therapies, can be achieved in most patients undergoing salvage cryotherapy. Therefore, salvage cryotherapy is a reasonable treatment choice for locally recurrent prostate cancer in appropriately selected patients.