Salvage cryotherapy following prostate cancer recurrence

Salvage cryotherapy (or cryosurgery or cyroablation) after failed radiation treatment for prostate cancer is a minimally invasive procedure that uses gases (such as liquid nitrogen) to freeze and destroy the cancer. Some physicians now use a “brachytherapy-like” approach to administer treatment.

To read more about the actual procedure, click here.

Based on case reports, Ismail et have suggested that men may respond better to this treatment if their PSA is less than 10 ng/mL, their PSA doubling time is less than 16 months, their biopsy Gleason score was less than or equal to 7, and their clinical stage prior to radiation treatment is T1/T2.

Some men may also receive hormone therapy for a few months prior to treatment.

An earlier study of 106 men that was reported by Han et al showed that the incidence of impotence was 87% in men who were previously potent. There were no cases of rectal fistulas (which previously were reported to be a problem with salvage cryotherapy) and the rate of incontinence was less than 10%.

Due to better monitoring equipment and modification of this technique, incontinence rates have dropped dramatically from what they were previously. Impotence rates, however, continue to remain high.

Cancer recurrence rates following this treatment have been reported to range from 25% to as high as 60%. A challenge is that there appears to be no consensus on how to define treatment failure.

Using data collected from the COLD (Cryo On-Line Data) Registry, Pisters et al reported that the 5-year biochemical disease-free rates were 58.9% (according to the older American Society of Therapeutic Radiology and Oncology definition of treatment failure, which is three consecutive rises in PSA) and 54.5%, according to the newer Phoenix definition of treatment failure (which is a PSA value that is higher than the man’s PSA nadir, plus 2 ng/mL). As predicted based on the preservation of some prostatic tissue, 83% of men had a detectable prostate specific antigen of 0.2 ng/mL or greater at 5 years.

Updated 5/09

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References:

Ahmed S, Lindsey B, Davies J. Salvage cryosurgery for locally recurrent prostate cancer following radiotherapy. Prostate Cancer and Prostatic Diseases. 2005;8:31–35.

Han KR, Cohen JK, Miller RJ, et al. Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol. 2003;170(4 Pt 1):1126-30.

Ismail M, Ahmed S, Kastner C, et al. Salvage cryotherapy for recurrent prostate cancer after radiation failure: A prospective case series of the first 100 patients. BJU Int. 2007;100:760-764.

Moul JW, Banez LL, Freedland SJ. Rising PSA in nonmetastatic prostate cancer. Oncology. 2007;21(12):1436-1454.

Pisters LL, Rewcastle JC, Donnelly BJ, Lugnani FM, Katz AE, Jones JS. Salvage prostate cryoablation: initial results from the cryo on-line data registry. J Urol. 2008;180(2):559-63; discussion 563-4.