|
Research
| Article |
Author(s) |
Source |
| Cryosurgery
is effective for radiotherapy failures |
Aaron E. Katz |
Urology Times,
September 2004 |
| Salvage
Cryotherapy Using an Argon Based System for Locally Recurrent
Prostate Cancer After Radiation Therapy: The Columbia
Experience |
Mohamed A. Ghafar,
Christopher W. Johnson, Alexander De La Taille, Mitchell
C. Benson, Emilia Bagiella, Marie Fatal, Carl A. Alsson
and Aaron E. Katz |
Journal of Urology
October 2001 |
| Selection
of Salvage Cryotherapy Patients |
Aaron E. Katz,
MD, Mohamed A. Ghafar, MD |
Reviews in Urology
2002 Vol. 4 Suppl. 2 |
References
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(3) Long et al., Urology 2001, 57:518-523.
(4) Onik et al., Urology 2002, 60:106-114.
(5) Bahn et al., Urology 2002, 60(Suppl 2A):3-11.
(6) Robinson et al., Urology 2002, 60(Suppl 2A):12-18.
(7) Katz and Bewcastle, Curr Oncl Rep 2003, 5(3):231-238.
(8) Walsh, J. Urology 2000, 163:1802-1807.
(9) Whrader-Bogen et al., Cancer 1997, 79:1977-1986.
(10) Lim et al., Urology 1995, 154:1420-1425.
(11) Incrocci et al., Int. J. Radit Oncol. Biol. Phys. 2002,
52(3):681-693.
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(17) http://urologyhealth.org/adult/index.cfm?cat=09&topic=42
Abstracts
Katz AE, Prepelica K, Masson P. Salvage Cryosurgical
Ablation of the Prostate (TCAP) for Patients Failing Radiation:
10-Year Experience. American Urologic Association Anual Meeting,
2005.
Treating localized prostate cancer after
failed radiation is a challenge due to first-line therapy
complications and aggressive radioresistant tumors. We report
observations from 157 patients treated with salvage cryoablation
between October 1994 and July 2004 with follow-up ranging
between 3 and 119 months (median 37 months). Mean and median
PSA nadirs were 0.8 and 0.1 ng/mL with 131 patients (83.4%)
reaching a nadir <1.0 ng/mL. Although radiation failure patients
typically present with comorbidities, patients in this series
enjoyed a relatively low rate of additional morbidities including
incontinence (9.7%), voiding complications (5.8%), rectal
pain (12.8%), and retention (1.9%). The 50 most recently treated
patients had an 83.3% ASTRO bRFS and 6.4% incontinence rate.
This 10-year experience with salvage cryoablation
for recurrent prostate cancer validates its safety and efficacy.
TCAP remains a viable option in the treatment of patients
who have biopsy-proven local failure after radiation therapy
for prostate cancer with significantly less complications
than radical surgery. (8) Walsh, J. Urology 2000, 163:1802-1807.
Onik G. The Male Lumpectomy: Rationale
for a Cancer Targeted Approach for Prostate Cryoablation.
A Review. Technol Cancer Res Treat. 2004 Aug;3(4): 365-70
Lumpectomy to treat breast cancer has revolutionized the management
of that disease. Lumpectomy showed that the quality of life
of the individual patient can successfully be integrated into
the equation of cancer treatment, without major loss of cancer
treatment efficacy. Prostate cancer raises many of the same
issues that breast cancer does in women. Impotence and incontinence,
affects the male self image and psyche no less than the loss
of a breast does a woman. Management of prostate cancer ranges
from no treatment at all ("watchful waiting") to
treatments in which the whole gland is destroyed (radiation
therapy, cryosurgery) or removed (radical prostatectomy),
with presently no treatment in between these extremes. Pathologic
literature indicates, however, that 35% of prostate cancers
are solitary and unilateral. In addition, long term studies
have confirmed that cryoabltion for prostate cancer is an
efficacious treatment. In this paper we will examine the rationale
for a "male lumpectomy" using cryoablation and present
preliminary data supporting it’s role in prostate cancer
management.
Bahn DK, Lee F, Silverman P, Bahn
E, et al. Salvage cryosurgery for recurrent prostate cancer
after radiation therap: a seven-year follow-up. Clin Prostate
Cancer. 2003;2(2):111-4
Cryosurgery of the prostate presents as an efficient therapy
following failed radiation therapy. We report on a 7-year
retrospective analysis evaluating the morbidity adn biochemical
disease-free survival(bDFS) of this therapy. Between 1993
and 2001, 59 patients who had been previously treated with
radiation therapy and had rising serum prostate-specific antigen(PSA)
values underwent salvage cryoablation of the prostate for
localized, histologically proven, recurrent prostate cancer.
Serial serum PSA testing was performed, and biopsies were
taken at 6, 12, and 24 months, and again at 5 years, and any
time the PSA rose above 0.5 ng/mL. Patients were stratified
along clinical parameters. The combined postsalvage bDFS rate
using a PSA cutoff of 0.5 ng/mL was 59% and 69% with a 1.0
ng/mL PSA cut off. Using a PSA threshold of 0.5 ng/mL as evidence
of biochemical recurrence, 61%, 62%, and 50% of patients with
<4 ng/mL, 4-10 ng/mL, and > 10 ng/mL PSA, respectively,
remain biochemically relapse free at 7 years. A threshold
of 1.0 ng/mL yielded a disease-free status of 78%, 74%, and
46% respectively. Patients biopsies showed no evidence of
residual or recurrent disease. Improved survival rates and
no known latent complications indicate cryosurgery is a promising
form of treatment for radiation-resistant prostate cancer.
This 7-year analysis shows a promising validation of cryosurgery
as an efficacious treatment modality for locally confined
T1-T3 prostate cancer following primary radiation therapy
failure.
Shinohara K. Prostate cancer: cryotherapy. Urol Clin
North Am. 2003;30(4):725-36, viii. Review.
The incidence of prostate cancer has more than doubled in
the last 10 years, and 220,900 new cases will be detected
in 2003. This increase is due in large part to increased use
of prostate-specific antigen (PSA)-based screening, transrectal
ultrasonography, and random biopsy of the prostate. The treatment
of prostate cancer, however, remains controversial, and no
consensus has been established as to what constitutes appropriate
treatment for any stage of disease, especially for localized
cancers. Radical prostatectomy, radiation therapy, or watchful
waiting all have their advocates, and the risks and benefits
of these approaches are discussed frequently. Skepticism about
conventional treatments has stimulated patients and physicians
to search for alternatives that are effective and associated
with limited morbidity. Technologic developments have rekindled
interest in cryotherapy as a viable alternative to other,
more conventional localized therapies. Given the relative
paucity of alternatives for patients who experience biochemical
progression after radiotherapy, cryosurgery also may prove
to be a good alternative for those patients whose tumors appear
to remain localized despite progression. In addition, it appears
that cryosurgery will play an increased role in the future
management of prostate cancer.
Johnson DB, Nakada SY. Cryoablation
of renal and prostate tumors. J Endourol. 2003;17(8):627-32.
Review.
During the past decade, cryoablation has been applied to benign
and malignant conditions within the prostate and kidney. The
essence of cryosurgery lies in producing temperatures low
enough to cause necrosis in target tissues while avoiding
lethal conditions in healthy peripheral tissues. It works
by two main mechanisms: (1) at the cellular level via solute
damage and intracellular ice formation; and (2) at the vascular
level as a result of thrombosis and subsequent coagulative
and ischemic necrosis. Investigation of cryoablation for renal
tumors began in 1964, and by the 1990s, attention was turning
to its use as a means of treating renal tumors. Modern renal
cryosurgery is applied using minimally invasive techniques.
Cryotherapy was first applied in the prostate in 1966 and
soon thereafter was used to treat prostate cancer. Today,
prostate cryosurgical techniques employ ultrasound monitoring
and urethral warming to minimize urethral and rectal complications.
Additional Information
WebMD
Questions and Answers about Cryosurgery in Cancer
Treatment
http://my.webmd.com/content/article/5/1680_50817.htm
Freezing Prostate Cancer Cells to Death
http://my.webmd.com/content/article/18/1688_50598.htm
‘Male Lumpectomy’ Works for Prostate Cancer
http://my.webmd.com/content/article/84/97994.htm
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