Should Cryosurgery Be Considered a Therapeutic Option in Localized Prostate Cancer?

Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer

“…Indeed, since the clinical trials of the Veterans Administration Co-operative Urological Research Group, which were conducted during the 1960s and early 1970s, the concept that early hormonal therapy retarded disease progression but did not prolong survival has been part of the dogma of prostate-cancer therapy. 3,4 In recent years, the availability of alternative forms of hormonal therapy [5][6][7] and the indications that radiotherapy or cryosurgery can be highly effective when directed at relatively small targets [8][9][10] have renewed interest in the use of androgen ablation in early disease. [10][11][12][13][14][15][16][17] In 1997, a randomized phase 3 study showed that early hormonal therapy combined with external-beam radiation prolonged survival in patients with locally advanced disease.…”

Cryotherapy

“…A number of disease-and treatment-related factors have been shown to predict rates of local control. In one series, for example, the likelihood of a positive biopsy was 9% for patients with clinical stage T1 or T2 disease, 58 Persistent or recurrent cancer is more likely in tumors located in the prostatic apex or seminal vesicles compared to those located in the mid-gland or base. 39 In their pooled analysis, Long et al 35 stratifi ed patients into three groups according to their risk of recurrence: low-risk patients (those with PSA ≤ 10 ng/ml, Gleason score ≤6, and clinical stage T1 or T2a disease), intermediate-risk patients (those with PSA > 10 ng/ ml, Gleason score ≥7, or clinical stage T2b or higher), and high-risk patients (those with two or three of these adverse risk factors).…”

Criocirugía en el tratamiento del cáncer de próstata

“…En experimentos in vitro con cultivos de células de cáncer de próstata, tanto en tejidos animales como humanos, se observa como temperaturas de -20 a -40ºC (o incluso más bajas), en función de la velocidad de congelación, son necesarias para conseguir la destrucción completa de las células de cáncer de próstata y que dos ciclos de congelación-descongelación tienen mayor capacidad destructiva que un ciclo único 10,17 . Estos dos aspectos son determinantes para conseguir una mayor eficacia terapéutica y condicionan la técnica de la criocirugía prostática en cuanto a disminución de los niveles de PSA y tasa de biopsias negativas después del tratamiento 26,27 .…”