What is the rate of prostate cancer recurrence after cryoablation?

Prostate Cancer Recurrence Rates After Cryoablation

The rate of prostate cancer recurrence after cryoablation ranges from approximately 15% to 40% at 5 years, with higher rates observed in patients with high-risk disease features. 1

Recurrence Rates by Risk Category

Recurrence rates after cryoablation vary significantly based on several factors:

By Risk Classification

• Low-risk disease: 11-15% recurrence rate at 5 years
• Intermediate-risk disease: 16-22% recurrence rate at 5 years
• High-risk disease: 20-31% recurrence rate at 5 years 2, 3

By Treatment Approach

• Whole-gland cryoablation: 5-year biochemical failure-free survival of 81% overall (meaning 19% recurrence rate) 2
• Hemigland (focal) cryoablation: 5-year biochemical failure-free survival of 62% (38% recurrence rate) 3

Predictors of Recurrence

Several factors predict higher likelihood of recurrence after cryoablation:

• PSA nadir: The most significant predictor of recurrence is failure to achieve a PSA nadir <0.2 ng/mL within 6 months post-cryoablation 2, 4

  • Patients with PSA nadir <0.1 ng/mL: 7-21% recurrence rate
  • Patients with PSA nadir 0.1-0.4 ng/mL: 22-48% recurrence rate
  • Patients with PSA nadir ≥0.5 ng/mL: 60-89% recurrence rate 4

• Baseline PSA: Higher baseline PSA independently predicts treatment failure, biochemical failure, and need for radical treatment 3

• Gleason Score/Grade Group: Grade Group 3 or greater independently predicts treatment failure 3

Anatomical Patterns of Recurrence

Recurrence after cryoablation shows specific anatomical patterns:

• Apex of prostate: 9.5% recurrence rate
• Seminal vesicles: 44% recurrence rate
• Mid-gland: 4% recurrence rate
• Base of prostate: 0% recurrence rate 4

The higher recurrence rates at the apex and seminal vesicles are likely due to technical challenges in achieving adequate freezing temperatures in these regions while avoiding damage to adjacent structures.

Timing of Recurrence

Most recurrences after cryoablation occur within the first 18 months after treatment 4. This underscores the importance of vigilant monitoring during this period with regular PSA testing.

Monitoring After Cryoablation

The American Urological Association (AUA) recommends:

1. PSA monitoring at 3,6, and 12 months post-treatment, then every 6 months thereafter
2. Prostate biopsy at 6 months or with biochemical failure (defined as PSA nadir ≥0.5 ng/mL or subsequent PSA increase ≥0.2 ng/mL) 1, 4

Salvage Options After Cryoablation Failure

For patients with recurrence after cryoablation, salvage options include:

1. Radical prostatectomy
2. Radiation therapy (including SBRT which has shown 76% disease control at 40 months median follow-up) 5
3. Whole-gland treatment (for patients who initially had focal ablation) 1

Pitfalls and Caveats

1. Definition variability: Different studies use different definitions of biochemical failure (Phoenix criteria of nadir+2 ng/mL vs. increase of ≥0.2 ng/mL), making direct comparisons challenging

2. Follow-up duration: Many studies have limited follow-up (median 3-5 years), potentially underestimating long-term recurrence rates

3. Technical factors: Recurrence rates may be influenced by operator experience, equipment used, and technical aspects of the procedure

4. Pre-treatment androgen deprivation: Neoadjuvant androgen blockade appears to reduce subsequent biochemical failure in patients with T1 and T2 cancers but not in those with T3 and T4 disease 4

5. Metastasis risk: Despite biochemical recurrence, the 5-year metastasis-free survival rate after cryoablation is reported to be 95-100% 2, 3, suggesting that many recurrences remain localized