Second Therapeutic Freeze After Salvage Cryoablation for Localized Radiorecurrent Prostate Cancer

OBJECTIVE: To report long-term oncologic and functional outcomes of a second therapeutic freeze (STF) after salvage cryoablation (sCryo) for biopsy-proven persistence following radiotherapy for localized prostate cancer. PATIENTS AND METHODS: We retrospectively reviewed 10 men with biopsy-proven local recurrence after sCryo following radiotherapy who underwent a STF. Outcomes were urinary and erectile function (social continence 0-1 pad/day; potency defined as International Index of Erectile Function-5 (IIEF-5) score ≥ 17), complications (Clavien-Dindo classification), and oncologic endpoints: failure-free survival (FFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). FFS was defined as the absence of Phoenix biochemical failure, radiographic progression, initiation of systemic therapy, or prostate cancer-specific death. MFS, CSS, and OS were time-to-event endpoints, estimated using Kaplan-Meier methods. RESULTS: Median follow-up was 77 months (Interquartile range [IQR] 37-133). The median interval between the cryoablations was 22 months (IQR 10-33). At 5 years, FFS was 52.5% (95% CI 15.0-80.4), MFS was 80.0% (95% CI 40.9-94.6), CSS was 87.5% (95% CI 38.7-98.1), and OS was 75.0% (95% CI 31.5-93.1). Median ADT/systemic-therapy deferral after STF was 19 months (IQR 9-42.5). After STF, 7/10 men were socially continent; and 6/10 were pad-free at 1 year. Both men who were potent pre-STF, remained potent. No Clavien-Dindo ≥ III complications were attributable to STF, though a rectourethral fistula was observed at 5 months post-STF in a single patient. CONCLUSION: In this limited cohort with intermediate- to long-term follow-up, STF after prior sCryo preserved genitourinary function and deferred ADT in select men with local recurrence after radiation and sCryo. While oncological outcomes are not equivalent to primary treatment, STF appears to be a feasible and reasonably safe option to extend local control in carefully selected candidates. Larger, prospective studies are needed before broader conclusions can be drawn.