Salvage Cryosurgery Effective for Recurrent Prostate Cancer

August 08, 2012

By Will Boggs MD

NEW YORK (Reuters Health) Aug 07 - When prostate cancer recurs after primary radiotherapy or cryosurgery, salvage cryotherapy may help, researchers say.

"Salvage treatment of the prostate with cryosurgery has been shown to be effective in many patients; it can be repeated if necessary, and rarely has side effects," Dr. Sven Wenske from Columbia University Medical Center, New York told Reuters Health by email. "We are excited to offer this therapy, as it appears to be effective and carries a favorable side effect profile."

Dr. Wenske and colleagues report on 328 men who had salvage cryosurgery for recurrent prostate cancer after primary radiotherapy or cryosurgery, in a paper published online July 20 in European Urology.

The median time from primary treatment to recurrence was 55 months.

The median PSA level before salvage therapy was 4.0 ng/mL. At a median of 2.6 months after salvage cryosurgery, the median PSA nadir was 0.2 ng/mL.

During follow-up after salvage cryotherapy (median, 47.8 months), 72 patients (22.3%) died of unrelated causes, and 35 (10.7%) died of prostate cancer-specific causes.

At five and 10 years, respectively, overall survival was 74% and 45%, disease-specific survival was 91% and 79%, and disease-free survival was 63% and 35%.

PSA nadir after salvage cryosurgery was the only significant predictor of disease-free and disease-specific survival after salvage cryosurgery, the authors report.

Significant complications requiring intervention included urethral stricture formation in 15 cases (4.6%), bladder outlet obstruction requiring a prostate volume-reduction intervention in 11 patients (3.4%), and rectourethral or urethroperineal fistula formation in 6 patients (1.8%).

"This study represents the largest series to date of patients who underwent salvage cryosurgery after primary therapy had failed and had good survival outcome," the researchers conclude. "Methods of identifying patients at high risk of failure after salvage cryosurgery still need to be better elucidated."

Results were similarly beneficial in the subset of patients who underwent focal salvage cryosurgery, and Dr. Wenske told Reuters Health that his group is currently assessing clinical, functional and oncologic outcomes after primary focal cryosurgery.

"We think a focal approach may be crucial in reducing side effects and improving quality of life for patients after this procedure, although it is important to again underscore that by no means can oncologic outcome be compromised, and that cancer cure will always remain the highest priority," he said.

Dr. Mohamed Ismail from St Luke's Cancer Center, Guildford, Surrey, UK has also published studies on salvage cryosurgery. He told Reuters Health, "I think cryosurgery should be offered as the first line treatment option for this group of patients."

SOURCE: http://bit.ly/O0Bv23

Eur Urol 2012.

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