760 Does Androgen Deprivation Therapy Before Salvage Cryotherapy Improve Treatment Outcomes

INTRODUCTION AND OBJECTIVES: Neoadjuvant androgen deprivation therapy (NADT) in prostate cancer patients has previously been studied when combined with radiation therapy (RT) or radical prostatectomy (RP). It has been shown in high risk prostate cancer patients that NADT prior to RT improves cause-specific and overall survival compared to RT alone. Conversely, NADT prior to RP decreases positive margins and early biochemical failure, but by 3 years biochemical failure is equivalent in NADT group compared to patients treated with RP alone. In patients suffering local failure after RT we sought to determine if treatment with androgen deprivation therapy (ADT) prior to salvage cryotherapy improved functional or biochemical outcomes when compared to similar patients treated with salvage cryotherapy alone. METHODS: Using the Cryo On-Line Data Registry (COLD), the records of 567 men treated with cryotherapy for biopsy proven recurrent prostate cancer following full dose radiation therapy were reviewed. The patients were stratified into two groups, those who received ADT prior to cryotherapy and those who did not receive ADT. Patients who received post-treatment ADT were excluded. Pre-treatment parameters, complications, functional outcomes, and biochemical failure using the Phoenix criteria were analyzed. The patients were stratified using D Amico criteria into low, intermediate and high-risk groups. RESULTS: 222 patients received ADT prior to salvage cryotherapy and 345 patients did not receive ADT. Freedom from biochemical failure at 5 years using the Phoenix criteria was 41.5% vs. 41.0% (p=0.47) for ADT and no ADT patients, respectively. Stratification into low, intermediate, and high-risk groups also showed no significant difference between ADT and no ADT groups using the Phoenix criteria (p= 0.27, 0.38, 0.87; respectively). Functional outcomes comparing ADT and no ADT at 12 months demonstrated decreased urine retention (3.6% vs. 15.4%; p=0.04) and incontinence (4.8% vs.7.3%; p=0.04) in the ADT group. Potency rates were not significantly different between the two groups (38.4% vs. 39.6%; p=0.07). Fistula rates were similar yet slightly lower in the group that did not receive ADT (1.8% vs. 1.4%; p=0.58l). CONCLUSIONS: This retrospective study of salvage cryotherapy found no difference in biochemical free survival between the pre-treatment ADT and no ADT groups, even when stratified by risk. There was significantly less risk of retention and incontinence with ADT, probably due to prostate size reduction. No statistically significant difference was found in potency or fistula rates.