ABSTRACT
Recurrence of prostate cancer following initial therapy may reflect the aggressive biologic nature of the original tumor or, conversely, may be caused by a technical malfunction occurring at the time of the initial treatment procedure, leading to failure to eradicate an otherwise curable cancer. In the latter case, the residual cancer may still be curable if subjected to a salvage procedure. This curative prospect, albeit small, justifies the use of aggressive means that would not normally be applied to patients with metastasis. The decision to use a salvage procedure versus hormonal treatment largely depends on patient factors such as performance status, comorbidities, and personal preferences; but also depends on the type of initial therapy that has been given. Data from a national disease registry of patients with prostate cancer, (Cancer of the Prostate Strategic Urologic Research Endeavor [CaPSURE]) shows that the type of salvage therapy following initial radical prostatectomy is equally divided between androgen deprivation therapy (ADT) and radiation therapy, whereas ADT is applied as salvage therapy following radiation therapy in more than 90% of cases.13 The available interventional procedures done in the other 10% of the patients who have failed radiation therapy include: salvage radical prostatectomy, salvage cystoprostatectomy or total pelvic exenteration, hyperthermia, and cryosurgery. The chapter will discuss cryosurgery as a post-radiation salvage procedure for prostate cancer.
