De La Taille A, Benson MC, Bagiella E, Burchardt M, Shabsigh
A, Olsson CA, Katz AE. BJU Int 2000
Department of Urology and Department of Biostatistics,
Columbia University College of Physicians and Surgeons, New York,
OBJECTIVE: To determine the complication rates and
biochemical recurrence after cryoablation of the prostate, using
an argon gas-based system, in patients with localized prostate cancer.
PATIENTS AND METHODS: Between October 1997 and June 1999, 35 patients
underwent cryoablation of the prostate (19 after radiation therapy
failure and 16 as a primary treatment for localized prostate cancer).
All patients had biopsy-confirmed prostate cancer with no seminal
vesicle invasion, negative bone scans and a negative lymph node
dissection. Patients received 3 months of combined hormonal therapy
before cryosurgery. One surgeon performed all the procedures. Biochemical
recurrence was defined by an increase in prostate specific antigen
(PSA) of >/= 0.2 ng/mL above the PSA nadir. RESULTS: The complications
were rectal pain (26%), urinary infection (3%), scrotal oedema (12%),
haematuria (6%) and incontinence (6%). Complication rates were higher
in those patients who failed after radiation therapy than in those
who did not receive radiation (incontinence 11% vs 0%, rectal pain
37% vs 12%) but the difference was not statistically significant.
Twenty-two patients (63%) had an undetectable serum PSA nadir (<
0.1 ng/mL) after cryotherapy and 30 (84%) patients had a PSA value
of < 1.0 ng/mL. After a mean follow-up of 8.3 months (range 0.2-18),
nine patients had biochemical recurrence. The biochemical recurrence-free
survival (BRFS) was 70% at 9 months. Patients who had an undetectable
PSA nadir had a statistically higher BRSF at 9 months than did patients
who had a detectable PSA nadir (89% vs 55%, respectively, P = 0.03).
Similarly, patients with a preoperative serum PSA level of <
10 ng/mL had a statistically higher BRFS than patients who had a
PSA level of > 10 ng/mL (86% vs 42% at 9 months, P < 0.001).
CONCLUSION: A PSA level before cryotherapy of < 10 ng/mL and
an undetectable PSA nadir after cryotherapy were associated with
the highest BRFS. Cryoablation of the prostate, with low morbidity,
seems to be a viable option in managing patients by salvage therapy
after radiation therapy and for the primary treatment of clinically
localized prostate cancer.