Results of Salvage Cryoablation of the Prostate After Radiation: Identifying Predictors of Treatment Failure and Complications

Chin, Joseph L.; Pautler, Stephen E.; Mouraviev, Vladamir; Touma, Naju; Moore, Kimberly A.; Downey, Dónal B.

doi:10.1016/s0022-5347(05)66246-5

Cited by 154 publications

(120 citation statements)

References 20 publications

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“…27 A cryotherapy salvage series reported from Ontario, Canada (n 5 118) defined biochemical control as PSA of 0.5 ng/mL. 28 At a median follow-up of 19 months, biochemical control defined as PSA <2 ng/ mL was achieved in 55% of patients, and persistent disease as identified by post-treatment biopsy was found in 6% of patients. If more stringent criteria for failure defined as PSA <0.5 ng/mL were to be used, then only 34% of patients would be defined as biochemically controlled.…”

mentioning

confidence: 99%

Management of prostate cancer recurrences after radiation therapy‐brachytherapy as a salvage option

Allen

Howard

Jarrard

et al. 2007

Cancer

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Depending on initial prognostic factors, an estimated 10%-60% of men who undergo definitive radiation therapy for prostate cancer may experience a biochemical recurrence. Even though hormonal therapy is standard for metastatic recurrences, no consensus exists on optimal salvage therapy for those recurrences thought confined to the prostate. Salvage treatment options for these local recurrences have historically been limited to salvage prostatectomy, hormonal therapy, or cryotherapy. Salvage prostate brachytherapy, however, uses a widely available technique and may provide another option for attaining disease control in patients with localized failures, although only about 110 cases have been reported in the literature. In this report, the authors have described their own series of salvage brachytherapy cases as well as presented a review of other such series reported in the literature. In addition, the authors included a comprehensive review of published experiences with surgery and cryotherapy as salvage options. It appears that salvage brachytherapy, when combined with careful patient selection, is at least as effective as other salvage options with comparable or potentially fewer treatment-related side effects.

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confidence: 99%

Management of prostate cancer recurrences after radiation therapy‐brachytherapy as a salvage option

Allen

Howard

Jarrard

et al. 2007

Cancer

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“…Details of the cryosurgery methodology have been reported previously. [11][12][13] Briefly, proper probe placement was confirmed on three-dimensional ultrasound in terms of inter-probe distances, probe orientation and depth of insertion. In most cases, five cryoprobes (range 2-8) were used and two freezethaw cycles were administered with the urethra protected by a urethra-warming device (Cook Urologic Inc., Spencer, IN, USA).…”

Section: Cryo Proceduresmentioning

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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“…In properly selected patients with cancer localized to the prostate after radiation therapy the cure rate with CSAP seems to be satisfactory [5]. Factors that were associated with positive biopsy include the initial stage, precryotherapy PSA, number of cryoprobes, number of freeze thaw cycles, and history of chemotherapy.…”

Section: Use Of Cryotherapy After Failure Of Radiation Therapymentioning

confidence: 99%

“…Complications of salvage CSAP are substantially higher than those of primary CSAP (in patients who had no prior radiotherapy). The most common complications were rectourethral fistula (3.3%), vesicourethral fistula (0.8%), incontinence, which was mild to moderate in 13.5% and severe in 6.7%, bladder outlet obstruction in 8.5%, debris sloughing in 5.1%, and bladder neck contracture (blockage due to scar tissue) in 1.6% [5].…”

Section: Use Of Cryotherapy After Failure Of Radiation Therapymentioning

confidence: 99%

Cryosurgery for Prostate Cancer

Fahmy

Bissada

2003

Archives of Andrology

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Results of Salvage Cryoablation of the Prostate After Radiation: Identifying Predictors of Treatment Failure and Complications

Cited by 154 publications

References 20 publications

Management of prostate cancer recurrences after radiation therapy‐brachytherapy as a salvage option

Management of prostate cancer recurrences after radiation therapy‐brachytherapy as a salvage option

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

Cryosurgery for Prostate Cancer

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