Cryosurgical Treatment of Localized Prostate Cancer (Stages T1 to T4): Preliminary Results

Shinohara, Katsuto; Connolly, John A.; Presti, Joseph C.; Carroll, Peter R.

doi:10.1016/s0022-5347(01)65958-5

Cited by 106 publications

(57 citation statements)

References 16 publications

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“…During the past 5 years, a number of reports have been published documenting the results after the use of transrectal ultrasound-guided cryoablation of the prostate for patients with PCA, [1][2][3] and these reports are not immune from the problems mentioned above. A number of investigators have suggested very promising preliminary results with regard to cancer-related outcomes such as biochemical disease-free survival or negative biopsy rates, and others have raised concerns regarding the potential morbidities of this procedure and the feasibility of safely accomplishing whole-gland ablations.…”

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confidence: 99%

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

Long

Bahn

Lee

et al. 2001

Urology

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Objectives. To define the potential role of cryosurgical ablation of the prostate (CSAP) as a treatment option for patients with localized prostate carcinoma (PCA), we performed a retrospective outcomes analysis of a large database of patients undergoing CSAP constructed from five institutions and compared this with matching outcomes from contemporary reports of patient outcomes after radiotherapy. Methods. A total of 975 patients who underwent CSAP as primary therapy from January 1993 to January 1998 with sufficient outcomes data available were identified. Patients were stratified into three groups on the basis of their clinical features. Biochemical-free survival (BFS), post-CSAP biopsy results, and post-CSAP morbidities were calculated and recorded. Results. The median follow-up for all patients was 24 months. The percentages of patients in the low, medium, and high-risk groups were 25%, 34%, and 41%, respectively. For prostate-specific antigen thresholds of less than 0.5 and less than 1.0 ng/mL, the 5-year actuarial BFS ranged from 36% to 61% and 45% to 76%, respectively, depending on the risk category. Overall, the positive biopsy rate was 18%. Morbidities included impotence in 93%, incontinence in 7.5%, rectourethral fistula in 0.5%, and transurethral resection of the prostate in 13% of patients (10% approved warming catheters versus 40% nonapproved). Conclusions. For each risk group, the 5-year BFS and positive biopsy rate after CSAP was comparable to matching outcomes reported after radiotherapy. Morbidities also seemed comparable, with impotence rates higher and rectal injury rates lower after CSAP than after radiotherapy. These data indicate that CSAP can be performed with low morbidity and can produce cancer-related results comparable to those reported for patients undergoing radiotherapy. UROLOGY 57: [518][519][520][521][522][523] 2001.

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confidence: 99%

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

Long

Bahn

Lee

et al. 2001

Urology

Self Cite

199

101

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“…29 Cryosurgery has emerged as a potential salvage procedure based on its success as a primary treatment. 14,15,30 The innovation of real-time TRUS for monitoring, new cryogenic technologies, the development of a urethral warming device, and thermosensor monitoring has been shown to limit morbidity and improve results. 31 Additionally, several venders now offer commercial cryogenic systems that use physical principles with high-pressure room temperature gases to achieve extreme cold (Joule-Thompson effect) rather than circulating liquid nitrogen (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…Cryosurgery was re-introduced as a primary treatment in 1989 by the radiology/urology team of Drs Onik and Cohen after their extensive modifications of the procedure to a more efficacious and safer procedure. [14][15][16]33 The trend of higher rates of morbidity in earlier series can likely be attributed to the lack of availability of thermocouples, the banning by the Food and Drug Administration of early urethral warmers, and the use of nitrogen-based cryogenic systems. Optimal surgical technique for cryoablation treatment of prostate cancer has recently been described, 34 and includes the use of two freeze/thaw cycles, FDA approved urethral warming devices, thermocouple monitoring, achieving temperatures of À401C or less, and six to eight cryoprobes per procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] Recently, cryosurgery has been advanced as an option for localized recurrence after radiotherapy based upon its successful application as a primary treatment for localized prostate cancer. [14][15][16] However, early results have been mixed and there have been some reports of a high frequency of severe complications in this population, particularly incontinence. 17 The purpose of this study was to prospectively evaluate the complication rates and biochemical recurrence rates following cryosurgical ablation of the prostate (CSAP) for patients with local recurrence after radical external beam radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

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Role of transrectal ultrasound guided salvage cryosurgery for recurrent prostate carcinoma after radiotherapy

Donnelly

Saliken

Ernst

et al. 2005

Prostate Cancer Prostatic Dis

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Despite improvements in treatment of localized prostate cancer, local recurrence remains a significant problem. A total of 46 patients with proven local cancer recurrence following external beam radiotherapy entered a prospective clinical trial using ultrasound-guided cryosurgery to ablate the residual prostate gland. Persistent complications included one urethra-rectal fistula, incontinence (2), retention (3), and treatment induced erectile dysfunction (7). Using the PSA definitions for biochemical failure as PSA X0.3 ng/ml, the Kaplan-Meier plots showed the incidence of patients to be free of biochemical recurrence at 51 and 44% at 1 and 2 y, respectively. For a PSA X1.0, the values at 1 and 2 y were 72 and 58%.

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“…For primary CRYO on clinical T3 and T4 disease, data were more scanty. 4,5 Miller et al 5 reported on a negative biopsy rate of 95% at 3 months but the mean prostate-specific antigen (PSA) nadir did not reach an undetectable level (0.59 ng/ml). Thus, although early results indicated reasonably effective short-term PSA control and low morbidity for primary CRYO, especially in lower-staged tumors, there were no randomized studies with higher level evidence to support this new technology.…”

Section: Introductionmentioning

confidence: 99%

Randomized trial comparing cryoablation and external beam radiotherapy for T2C-T3B prostate cancer

Chin

Touma

et al. 2007

Prostate Cancer Prostatic Dis

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The objective was to evaluate the relative efficacy of cryoablation (CRYO) versus external beam radiation (EBRT) for clinically locally advanced prostate cancer in a randomized clinical trial. Patients with histologically proven, clinically staged as T2C, T3A or T3B disease were randomized with 6 months of perioperative hormone therapy to one of the two procedures. Owing largely to a shift in practice to longer term adjuvant hormonal therapy and higher doses of radiation for T3 disease, only 64 out of the planned 150 patients were accrued. Twenty-one of 33 (64%) in the CRYO group and 14 of 31 (45%) in the EBRT-treated group who had met the ASTRO definition of failure were also classified as treatment failure. The mean biochemical disease-free survival (bDFS) was 41 months for the EBRT group compared to 28 months for the CRYO group. The 4-year bDFS for EBRT and CRYO groups were 47 and 13%, respectively. Disease-specific survival (DSS) and overall survival (OS) for both groups were very similar. Serious complications were uncommon in either group. EBRT patients exhibited gastrointestinal (GI) adverse effects more frequently. Taking into account the relative deficiency in numbers and the original trial design, this prospective randomized trial indicated that the results of CRYO were less favorable compared to those of EBRT, and was suboptimal primary therapy in locally advanced prostate cancer.

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Cryosurgical Treatment of Localized Prostate Cancer (Stages T1 to T4): Preliminary Results

Abstract: Cryosurgical ablation of the prostate can result in negative posttreatment biopsies and undetectable serum PSA levels. However, it is associated with significant side effects and the long-term durability of the procedure is unknown.

Cited by 106 publications

References 16 publications

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate

Role of transrectal ultrasound guided salvage cryosurgery for recurrent prostate carcinoma after radiotherapy

Randomized trial comparing cryoablation and external beam radiotherapy for T2C-T3B prostate cancer

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