|Salvage cryotherapy using an argon
based system for locally recurrent prostate cancer after radiation
therapy: the Columbia experience.
Ghafar MA, Johnson CW, De La Taille A,
Benson MC, Bagiella E, Fatal M, Olsson CA, Katz AE.
Department of Urology, College of Physicians and
Surgeons of Columbia University, New York, New York, USA.
PURPOSE: Cryosurgical ablation of the prostate has
been reported as potential treatment for radioresistant clinically
localized prostate cancer. We report our experience with the safety
and efficacy of salvage cryosurgery using the argon based CRYOCare
system (Endocare, Inc, Irvine, California). MATERIALS AND METHODS:
Between October 1997 and September 2000, 38 men with a mean age
of 71.9 years underwent salvage cryosurgery for recurrent prostate
cancer after radiation therapy failed. All patients had biochemical
disease recurrence, defined as an increase in prostate specific
antigen (PSA) of greater than 0.3 ng./ml. above the post-radiation
PSA nadir. Subsequently prostate biopsy was positive for cancer.
Pre-cryosurgery bone scan demonstrated no evidence of metastatic
disease. In addition, these patients received 3 months of neoadjuvant
androgen deprivation therapy before cryotherapy. RESULTS: The PSA
nadir was 0.1 or less, 1 or less and greater than 1 ng./ml. in 31
(81.5%), 5 (13.2%) and 2 (5.3%) patients, respectively. Biochemical
recurrence-free survival calculated from Kaplan-Meier curves was
86% at 1 year and 74% at 2 years. Reported complications included
rectal pain in 39.5% of cases, urinary tract infection in 2.6%,
incontinence in 7.9%, hematuria in 7.9% and scrotal edema in 10.5%.
The rate of rectourethral fistula, urethral sloughing and urinary
retention was 0%. CONCLUSIONS: Our study supports cryosurgery of
the prostate as safe and effective treatment in patients in whom
radiation therapy fails. Using the CRYOCare machine resulted in
a marked decrease in complications.