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Purpose:

A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full dose radiation therapy and/or systemic therapy. The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen (PSA) levels and prostate biopsies as end points.

Materials and Methods:

A total of 150 patients with locally recurrent prostate cancer following radiation, hormonal therapy and/or systemic chemotherapy underwent salvage cryotherapy using a single (71 men, mean followup 17.3 months) or double (79 men, mean followup 10.0 months) freeze-thaw cycle. PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively. Complications were assessed by retrospective chart review and a mailed quality of life survey.

Results:

Overall, 45 patients (31%) had persistently undetectable PSA. Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate (93 versus 71%, p <0.02) and lower biochemical failure rate (defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value, 44 versus 65%, p <0.03) than those who underwent a single freeze-thaw cycle. The main complications of salvage cryotherapy were urinary incontinence (73% of the patients), obstructive symptoms (67%), impotence (72%) and severe perineal pain (8%).

Conclusions:

Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies. A double freeze-thaw cycle appears more effective than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes significant morbidity.

References

  • 1 : Analysis of independent variables affecting survival after recurrence of prostate cancer. Int. J. Rad. Oncol. Biol. Phys.1989; 16: 1431. Google Scholar
  • 2 : Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels. J. Urol.1995; 153: 104. LinkGoogle Scholar
  • 3 : Critical evaluation of salvage surgery for radiorecurrent/resistant prostate cancer. J. Urol.1995; 154: 1103. LinkGoogle Scholar
  • 4 : Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer1993; 72: 1291. Google Scholar
  • 5 : Quality-of-life outcomes in men treated for localized prostate cancer. J.A.M.A.1995; 273: 129. Crossref, MedlineGoogle Scholar
  • 6 : Percutaneous cryoablation of the prostate: preliminary results after 95 procedures. J. Urol.1995; 154: 1813. LinkGoogle Scholar
  • 7 : Percutaneous transperineal cryosurgical ablation of the prostate for the primary treatment of clinical stage C adenocarcinoma of the prostate. Urology1994; 44: 170. Google Scholar
  • 8 : Transrectal ultrasound-guided transperineal cryoablation in the treatment of prostate carcinoma: preliminary results. J. Urol.1995; 154: 435. LinkGoogle Scholar
  • 9 : Cryosurgical ablation of the prostate: patterns of failure and two year post treatment data as compared to external beam radiation therapy. J. Urol., part 21995; 153: 503A. abstract 1098. Google Scholar
  • 10 : Short-term outcomes after cryosurgical ablation of the prostate in men with recurrent prostate carcinoma following radiation therapy. Urology1995; 46: 676. Crossref, MedlineGoogle Scholar
  • 11 : Percutaneous, transperineal cryosurgery of the prostate as salvage therapy for post radiation recurrence of adenocarcinoma. Cancer1996; 77: 1510. Google Scholar
  • 12 : Repeated “freeze-thaw” as cryotherapeutic technique. Arch. Dermatol. Syphilol.1954; 70: 520. Google Scholar
  • 13 : Cryotherapy for cancer of the lip and oral cavity. Cancer1965; 18: 1646. Google Scholar
  • 14 : Cryosurgery of malignant and benign tumors. Fed. Proc.1965; 24: S-241. Google Scholar
  • 15 : A method for cryosurgical investigation of mouse tumors. Int. Surg.1969; 52: 232. Google Scholar
  • 16 : Cryosurgery of experimental tumors. J. Cryosurg.1969; 2: 225. Google Scholar
  • 17 : Repeated freeze-thaw cycles in cryosurgery. Nature1968; 219: 410. Google Scholar
  • 18 : Experimental cryogenic injury of the palate: observations pertinent to cryosurgical destruction of tumors. Cryobiology1978; 15: 415. Google Scholar
  • 19 : Long-term followup of incontinence and obstruction after salvage cryosurgical ablation of the prostate: results in 143 patients. J. Urol.1997; 157: 237. LinkGoogle Scholar
  • 20 : Complications of cryosurgical ablation of the prostate to treat localized adenocarcinoma of the prostate. Urology1995; 45: 932. Google Scholar
  • 21 : Prevention and treatment of incontinence after radical prostatectomy. Sem. Urol. Oncol.1995; 13: 224. Google Scholar

Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

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