Quality of life after salvage cryotherapy: The impact of treatment parameters

Purpose: Cryotherapy has emerged as a promising salvage therapy option for treatment of locally recurrent prostate cancer after initial therapy. In this retrospective study we evaluate patient quality of life after salvage cryotherapy and correlate complications impairing quality of life with specific cryotherapy treatment parameters, Materials and Methods: A modified UCLA Prostate Cancer Index measuring health related quality of life was sent to 150 patients who underwent salvage cryotherapy between July 1992 and April 1995. We evaluated the relationships among incontinence, pain, impotence, sloughing of tissue and problematic voiding symptoms, and cryotherapy treatment parameters, including use of a urethral warming catheter, number of cryotherapy probes and number of freeze-thaw cycles. We also evaluated patient overall degree of satisfaction with the procedure. Results: Of 150 surveys 112 (74%) were returned. Mean followup was 16.7 months (range 0.5 to 31.5). Treatment without an effective urethral warming catheter was highly associated with urinary incontinence (p < 0.003), perineal pain (p < 0.001), tissue sloughing (p < 0.003) and American Urological Association symptom score greater than 20 (p < 0.004). Impotence was higher in the double freeze-thaw cycle group (p < 0.05). Overall satisfaction with cryotherapy was 33%. Conclusions: Quality of life may be compromised by urinary incontinence, impotence, tissue sloughing, problematic voiding symptoms and/or perineal pain in a substantial number of patients following salvage cryotherapy. Effective urethral warming is essential in reducing complications and maximizing quality of life. Salvage cryotherapy does not appear to offer any quality of life advantages compared to salvage prostatectomy.