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

Abstract

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.

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer

“…12,22 CRYO outcomes are similarly unclear and have been reported many ways, including threshold criteria and the first ASTRO definition. [7][8][9] Currently, there is no universally agreed upon definition of …”

“…7,8 We previously reported a phase 2 CRYO series with 5-year probabilities of maintaining a prostate-specific antigen (PSA) level 1.0 ng/mL for low-risk, intermediate-risk, and high-risk patients of 75%, 89%, and 76%, respectively. 9 Herein, we present the results of our singleinstitution, randomized trial in which we compared EBRT with CRYO for clinically localized prostate cancer at the Tom Baker Cancer Center.…”

Cryosurgery for Prostate Cancer

“…The patients with medium risk had a 67% biochemical freedom of disease, and for high-risk patients it was 41%. These results are encouraging and place cryotherapy between radical prostatectomy and radiotherapy (EBRT and BT) in effectiveness [12].…”

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

“…Originally accepted primarily for salvage after local failure of radiation therapy, cryoablation is now used increasingly often as a primary treatment. Results from several large studies have showed that cryoablation of the prostate provides a long-term, durable response with regard to disease control [16]. Recent advances in technology for cryoablation have also produced significant decreases in associated complications and morbidity.…”