Salvage cryotherapy

Treatment for prostate cancer recurrence

Salvage cryotherapy (or cryosurgery or cyroablation) is a minimally invasive treatment that may be used after radiation treatment for prostate cancer has failed.

Gases (such as liquid nitrogen or argon/helium) are used to freeze and destroy the cancer.  Some physicians now use a “brachytherapy-like” approach to administer treatment.

Based on case reports (not a large-scale study), Ismail et have suggested that a man may respond better to salvage cryoablation if his:

  • PSA is less than 10 ng/mL
  • PSA doubling time is less than 16 months
  • Gleason score was less than or equal to 7
  • Clinical stage prior to radiation treatment is T1/T2

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

Can it help?

Cancer recurrence rates following salvage cryosurgery have been reported to range from 34% to 68%.

A big challenge is that there is really no consensus among physicians about how to define treatment failure.

Clinical study data

Looking at data collected from the COLD (Cryo On-Line Data) Registry, Pisters et al reported 5-year biochemical disease-free rates of:

  • 58.9%, according to the older American Society of Therapeutic Radiology and Oncology definition of treatment failure (three consecutive rises in PSA)
  • 54.5%, according to the newer Phoenix definition of treatment failure (PSA value that is higher than the man’s PSA nadir, plus 2 ng/mL)
  • 83% of men had a detectable prostate specific antigen of 0.2 ng/mL or greater at 5 years

Ten-year survival rates

In a 10-year study (Cheetham et al), researchers looked at the medical records (called a retrospective study) of 76 men who had:

  • A mean Gleason score of 7
  • A mean age of 69.2
  • Prostate cryotherapy before January 1999

After 10 years:

  • 43 of 76 men (56.6%) were still alive
  • 33 men (43.4%) had died from prostate cancer
  • 18 men (22.4%) died from noncancerous causes
  • 5 men (6.6%) died from unknown causes

In another study, Williams et al reported an 87% overall 10-year survival rate.

Questions to ask the doctor about salvage cryotherapy

  • How you define treatment success?
  • How do you define prostate cancer recurrence?
  • How do you define incontinence?
  • How do you define impotence? 
  • Will you combine this treatment with hormone therapy?
  • What are the options if this treatment does not work?

Side effects

An earlier study of 106 men that was reported by Han et al showed that:

  • Rate of impotence was 87% in men who were previously potent
  • Rate of incontinence was less than 10%
  • There were no cases of rectal fistulas (which previously were reported to be a problem with salvage cryotherapy)

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 (60% to 80%).

The procedure

The salvage cryotherapy procedure is just like regular cryosurgery.  Learn more.

Back to if cancer returns
Salvage radiation
Salvage radical prostatectomy
Hormone treatment
Chemotherapy
Watchful waiting (or active surveillance)

References:

Finley D, Belldegrun A.  Salvage cryotherapy for radiation-recurrent prostate cancer.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090573/.  Accessed March 29, 2015.

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

Cheetham P, Truesdale M, Chaudhury S, et al. Long-term cancer-specific and overall survival for men followed more than 10 years after primary and salvage cryoablation of the prostate. J Endourol. 2010 Jul;24(7):1123-9.

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.

Always consult a medical professional.

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