Treatment of Prostate Cancer Local Recurrence After Whole-Gland Cryosurgery With Frameless Robotic Stereotactic Body Radiotherapy: Initial Experience

BackgroundThe use of frameless robotic stereotactic body radiotherapy has not been investigated in patients whose primary cryosurgery treatment failed. The aim of this series was to present initial experiences with frameless robotic radiosurgery in the treatment of local prostate recurrence after cryotherapy.MethodsWe reviewed the outcome of frameless robotic radiosurgery in 4 patients for biopsy-proven local recurrent prostate cancer after cryotherapy. The patients underwent stereotactic body radiation therapy (SBRT) at Winthrop University Hospital, Mineola, New York.ResultsThe patients' ages ranged from 66 to 75 years old. The average follow-up was more than 4 months. Presalvage prostate-specific antigen (PSA) levels were 7.3, 11.9, 6.1, and 20.9 ng/mL for the four patients. Presalvage Gleason scores were 7, 7, 9, and 8 respectively. One patient had insufficient follow-up for inclusion. The 3 remaining patients showed reduction of PSA levels after SBRT. Follow-up post-SBRT PSA levels were 2.2, 0.19, and 2.0 ng/mL. The average PSA reduction was 7.0 ng/mL. Morbidity at 3-week follow-up included urinary urgency, dysuria, and constipation. There was no change in international prostate symptom score or The International Consultation on Incontinence Questionnaire-Short Form scores after SBRT. One patient experienced erectile dysfunction from SBRT.ConclusionsInitial results indicate that robotic SBRT is a viable option for patients who have failed initial cryosurgery therapy measures. The patients had minimal morbidity with significant reduction in PSA levels.