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“Selection of Salvage Crotherapy Patients”
Aaron E. Katz, MD, Mohamed A. Ghafar, MD Rev Urol. 2002;4(suppl 2):S18-S23.
In this study all patients had localized
prostate
cancer proven through a biopsy
and received hormone
therapy for 3 months prior to cryotherapy using
the Cryocare unit. Doctors followed up with their patients
approximately 21 months after this minimally invasive
surgery. Of the patients, 65% remained free of biochemical
recurrence after 3 three years. With the use of the
external sphincter thermocouple,
urinary incontinence
rates have dropped to 5% and below. Rectal fistula is
near 0%. These results indicate that salvage cryotherapy
guided by ultrasound monitoring may prove beneficial
to patients with recurrent localized prostate cancer
after radiation therapy. As the technique is refined
more effective results take place.
“Cryotherapy for PCa: The Next Generation Innovative Biofeedback Applications in Urology”
John S. Lam, M.D., Oleg Shvarts, M.D., and Arie S. Belldegrun, M.D. Contemporary Urology, October 2004, Vol. 16, No. 10, 2-12
Many patients are often left with
the option of salvage cryotherapy
after failures in salvage
prostatectomy, brachytherapy,
or radiotherapy
are realized. In a study of 29 patients who had undergone
salvage cryotherapy at UCLA using the SeedNet system,
complications were minimal. All patients received a
biopsy proven recurrence without metastasis and after
12 months 13 of 18 (72%) have maintained a PSA of .4ng/mL
or less. Dr. Katz reported on a 6-year outcome with
67 salvage cryotherapy patients, using multiple thermocouples
and 3 months hormone therapy prior to the procedure.
Out of 67, 48 (72%) remained free of biochemical recurrence
after 12 months. Dr. Chin and associates identified
only 3.1% with persistent disease remaining with the
use of an argon-based system in 118 patients. In 114
with a PSA nadir less than .5ng/mL, 34% showed no biochemical
evidence of disease after 18 months.
“Results of Salvage Cryoablation of the Prostate After Radiation: Identifying Predictors of Treatment Failures and Complications”
Joseph L. Chin,* Stephen E. Pautler, Vladamir Mouraviev,† Naju Touma, Kimberly Moore and Donal B. Downey. The Journal Of Urology® Vol. 165, 1937–1942, June 2001 Copyright © 2001 by American Urological Association, Inc.
Physicians in this study tracked
118 patients with proved local recurrence for 6, 12,
and 24 months that had received cryotherapy after full
dose radiotherapy.
Patients were placed into one of three risk groups based
on clinical characteristics. The results revealed that
114 had a PSA less than .5 after 18.6 months. Only 7
patients or 3.1% (23 of 745) showed a biopsy core containing
persistent cancer. Approximately 87% remained free of
histologic failure. Those with a PSA level greater than
4 exhibited 68% biochemical failure, at 2 it reached
55%, and at .5 it reached 34%. Prior to cryotherapy,
patients who had a PSA greater than 10, a Gleason score
of 8 or greater before radiation, and a stage T3/T4
did not respond as well.
“Salvage Cryotherapy for Recurrent Prostate Cancer After Radiation Therapy: The Columbia Experience”
Alexandre De La Taille, Omar Hayek, Mitchell C. Benson, Emilia Bagiella, Carl A. Olsson, Marie Fatal, And Aaron E. Katz. UROLOGY 55: 79–84, 2000. © 2000, Elsevier Science Inc.
During this study 43 patients with
biopsy proven recurrent prostate cancer underwent salvage
cryoablation between October 1994 and April 1999. Physicians
tracked their outcomes at 21.9 months. Prior to this
treatment all patients received 3 months of combined
hormone therapy. External-beam
radiation therapy was administered at least 18 months
before an evaluation took place to determine which patients
were eligible. Postoperatively some complications occurred
including incontinence (9%), obstruction (5%), urethral
stricture (5%), rectal pain (26%), urinary infection
(9%), scrotal edema (12%), and hematuria
(5%). Patients whose PSA level was less than .1 consisted
of 26 (60%), 16 (37%) had a PSA less than 4, and 1 (3%)
had less than 10. After 6 months 79% experienced biochemical
recurrence-free survival and at 12 months this rate
remained at 66%. |
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