Cryosurgical ablation of the prostate

Abstract

BACKGROUND The authors report their experience with cryosurgical ablation of the prostate in men with high‐risk features for prostate carcinoma who were unwilling to undergo radical surgery or radiation therapy. METHODS Between January 1998 and April 2002, 65 men underwent primary cryosurgery for prostate carcinoma with high‐risk features. All patients had biopsy‐proven prostate carcinoma without evidence for metastatic disease on magnetic resonance images, computed tomography scans, or radionuclide images of bones. High‐risk parameters were defined as either a prostate‐specific antigen (PSA) level ≥ 10 ng/mL, or a Gleason sum score ≥ 8, or both. Patients who had undergone prior surgery, radiation therapy, or cryoablation for prostate carcinoma were excluded from the study. Patients were monitored with physical examination and PSA screening every 3 months and with radiologic imaging when indicated. RESULTS The median patient age was 72 years (range, 41–86 years), and t he median follow‐up was 35 months (range, 4–77 months). There were 2 patients (3.1%) with rectal pain and incontinence. Durable PSA biochemical disease‐free survival was noted in 83.3% of patients according to the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria. A 6‐year Kaplan–Meier analysis revealed an 81.7% ASTRO survival probability as well as PSA nadir < 4.0 ng/mL and PSA nadir < 1.0 ng/mL projections of 50% and 35%, respectively. One of 8 postcryosurgery biopsies (12.5%) were positive. No patient had progressed at last follow‐up, and the overall survival rate was 100%. CONCLUSIONS Cryoablation was a feasible treatment option in patients with organ‐confined prostate carcinoma who had high‐risk features. Longer follow‐up will be necessary to determine the effectiveness of this approach. Cancer 2005. © 2005 American Cancer Society.

Targeted induction of apoptosis via TRAIL and cryoablation: a novel strategy for the treatment of prostate cancer

“…5,43,44 Targeted induction of programmed cell death via the extrinsic apoptotic pathway represents an additional unexploited therapeutic strategy that can be combined with cryoablation to destroy cancer cells. The adjuvant strategy is an effective method to reduce the critical freezing temperature, thereby reducing the need to extend the freeze zone beyond the targeted tissue.…”

The biochemical efficacy of primary cryoablation combined with prolonged total androgen suppression compared with radiotherapy on high-risk prostate cancer: a 3-year pilot study

“…In this series, because we focused on the high-risk patient group, including localized and locally advanced disease in which systemic disease is likely, all patients had received adjuvant ADT for 24 months after primary CSAP. The theory that these patients eventually fail because they already have local or distant micro-metastatic disease at the time of diagnosis is the rationale for prolonged neoadjuvant or adjuvant hormone therapy in high-risk patients [12].…”

“…Cryosurgical ablation of the prostate with shortterm ADT for 3-6 months had been utilized in several series, mainly for the purpose of comparison with radiotherapy [10][11][12]. However, in terms of ADT in a combination strategy, the method and duration has not been clearly established.…”

The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach

“…Additionally, with early detection there has also been increased interest in focal "diseasetargeted" therapies, including interstitial brachytherapy, intensity-modulated radiotherapy, focal cryosurgery, and radiofrequency ablation which can potentially reduce treatment-related morbidity and allow patients to maintain their quality of life [19][20][21][22][23][24]. These therapies require an improved knowledge of the location and spatial extent of the disease within the gland.…”