SALVAGE CRYOTHERAPY USING AN ARGON BASED SYSTEM FOR LOCALLY RECURRENT PROSTATE CANCER AFTER RADIATION THERAPY: THE COLUMBIA EXPERIENCE
Abstract
Purpose:
Cryosurgical ablation of the prostate has been reported as potential treatment for radioresistant clinically localized prostate cancer. We report our experience with the safety and efficacy of salvage cryosurgery using the argon based CRYOCare system (Endocare, Inc, Irvine, California).
Materials and Methods:
Between October 1997 and September 2000, 38 men with a mean age of 71.9 years underwent salvage cryosurgery for recurrent prostate cancer after radiation therapy failed. All patients had biochemical disease recurrence, defined as an increase in prostate specific antigen (PSA) of greater than 0.3 ng./ml. above the post-radiation PSA nadir. Subsequently prostate biopsy was positive for cancer. Pre-cryosurgery bone scan demonstrated no evidence of metastatic disease. In addition, these patients received 3 months of neoadjuvant androgen deprivation therapy before cryotherapy.
Results:
The PSA nadir was 0.1 or less, 1 or less and greater than 1 ng./ml. in 31 (81.5%), 5 (13.2%) and 2 (5.3%) patients, respectively. Biochemical recurrence-free survival calculated from Kaplan-Meier curves was 86% at 1 year and 74% at 2 years. Reported complications included rectal pain in 39.5% of cases, urinary tract infection in 2.6%, incontinence in 7.9%, hematuria in 7.9% and scrotal edema in 10.5%. The rate of rectourethral fistula, urethral sloughing and urinary retention was 0%.
Conclusions:
Our study supports cryosurgery of the prostate as safe and effective treatment in patients in whom radiation therapy fails. Using the CRYOCare machine resulted in a marked decrease in complications.
References
- 1 : Cancer statistics, 1997. CA Cancer J Clin1997; 47: 5. Google Scholar
- 2 : The National Cancer Data Base report on prostate cancer. Cancer1994; 74: 1640. Google Scholar
- 3 Katz, A.: Cryosurgery in the radiation failure patient. Proceedings of the World Congress of Cryosurgery, Orlando, Florida, October 30, 1998 Google Scholar
- 4 : Treatment of prostate cancer: watchful waiting, radical prostatectomy, and cryoablation. Semin Surg Oncol2000; 18: 37. Google Scholar
- 5 : Treatment options for localized recurrence of prostate cancer following radiation therapy. Urol Clin North Am1996; 23: 677. Crossref, Medline, Google Scholar
- 6 : Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer1993; 72: 1291. Google Scholar
- 7 : The efficacy and complications of salvage cryotherapy of the prostate. J Urol1997; 157: 921. Link, Google Scholar
- 8 : PSA after definitive radiotherapy for clinically localized prostate cancer. Urol Clin North Am1993; 20: 727. Google Scholar
- 9 : Identification of residual cancer in the prostate following radiation therapy: role of transrectal ultrasound guided biopsy and prostate specific antigen. J Urol1989; 142: 326. Link, Google Scholar
- 10 : Proliferative cell nuclear antigen in postradiotherapy prostate biopsies. Int J Radiat Oncol Biol Phys1994; 30: 303. Google Scholar
- 11 : Complication of 125 iodine implantation and pelvic lymphadenectomy for prostatic cancer with special reference to patients who had failed external beam therapy as their initial mode of therapy. J Urol1981; 126: 620. Abstract, Google Scholar
- 12 : Adjuvant cytotoxic chemotherapy in association with radical surgery or radical radiation treatment in presumably localized prostatic cancer. Acta Oncol1991; 30: 259. Google Scholar
- 13 : Quality of life and treatment outcomes: prostate carcinoma patients’ perspectives after prostatectomy or radiation therapy. Cancer1997; 79: 1977. Google Scholar
- 14 :
Salvage surgery following full dose radiation therapy for prostate cancer . In: Atlas of Surgical Oncology. Edited by . Philadelphia: W. B. Saunders1995: 605. Google Scholar - 15 : Quality-of-life outcomes in men treated for localized prostate cancer. JAMA1995; 273: 129. Crossref, Medline, Google Scholar
- 16 : Combination perineal cryosurgery and external radiation therapy for adenocarcinoma of prostate. Urology1984; 24: 11. Google Scholar
- 17 : Complications of cryosurgical ablation of the prostate to treat localized adenocarcinoma of the prostate. Urology1995; 45: 932. Google Scholar
- 18 : Transrectal ultrasound-guided transperineal cryoablation in the treatment of prostate carcinoma: preliminary results. J Urol1995; 154: 435. Link, Google Scholar
- 19 : Short-term outcomes after cryosurgical ablation of the prostate in men with recurrent prostate carcinoma following radiation therapy. Urology1995; 46: 676. Crossref, Medline, Google Scholar
- 20 : Salvage surgery for radiation failure in prostate cancer. Cancer1993; 71: 976. Google Scholar
- 21 : Salvage surgery plus androgen deprivation for radioresistant prostatic adenocarcinoma. J Urol part 21992; 147: 900. Abstract, Google Scholar
- 22 : Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels. J Urol1995; 153: 104. Link, Google Scholar
- 23 : Cryosurgery of prostate cancer. Use of adjuvant hormonal therapy and temperature monitoring: a one year follow-up. Anticancer Res1997; 17: 1511. Google Scholar
- 24 : Deoxyribonucleic acid ploidy and serum prostate specific antigen predict outcome following salvage prostatectomy for radiation refractory prostate cancer. J Urol1999; 161: 857. Link, Google Scholar
- 25 : Percutaneous, transperineal cryosurgery of the prostate as salvage therapy for post radiation recurrence of adenocarcinoma. Cancer1996; 77: 1510. Google Scholar
- 26 : Cryosurgery in prostatic cancer: survival. Urology1982; 19: 37. Google Scholar
- 27 : Cryoablation of localized prostate cancer. Experience in 48 cases, PSA and biopsy results. Eur Urol1998; 34: 181. Google Scholar
- 28 :
Carcinoma of the prostate . In: . Edited by . St. Louis: Mosby-Year Book1991: 1277. Google Scholar
From the Department of Urology, College of Physicians and Surgeons of Columbia University, New York, New York
