The efficacy and complications of salvage cryotherapy of the prostate

Louis L. Pisters, Andrew C. Von Eschenbach, Shellie M. Scott, David A. Swanson, Colin P.N. Dinney, Curtis A. Pettaway, R. Joseph Babaian

Research output: Contribution to journalArticle

193 Citations (Scopus)

Abstract

Purpose: A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full close radiation therapy and/or systemic therapy. The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen (PSA) levels and prostate biopsies as end points. Materials and Methods: A total of 150 patients with locally recurrent prostate cancer following radiation, hormonal therapy and/or systemic chemotherapy underwent salvage cryotherapy using a single (71 men, mean follow up 17.3 months) or double (79 men, mean follow up 10.0 months) freeze-thaw cycle. PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively. Complications were assessed by retrospective chart review and a mailed quality of life survey. Results: Overall, 45 patients (31%) had persistently undetectable PSA. Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate (93 versus 71%, p <0.02) and lower biochemical failure rate (defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value, 44 versus 65%, p <0.03) than those who underwent a single freeze-thaw cycle. The main complications of salvage cryotherapy were urinary incontinence (73% of the patients), obstructive symptoms (67%), impotence (72%) and severe perineal pain (8%). Conclusions: Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies. A double freeze-thaw cycle appears more effective than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes significant morbidity.

Original languageEnglish (US)
Pages (from-to)921-925
Number of pages5
JournalJournal of Urology
Volume157
Issue number3
DOIs
StatePublished - Mar 1997

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Cryotherapy
Prostate
Prostate-Specific Antigen
Biopsy
Radiotherapy
Prostatic Neoplasms
Urinary Incontinence
Erectile Dysfunction
Prostatectomy
Quality of Life
Morbidity
Drug Therapy
Pain
Therapeutics
Serum
Neoplasms

Keywords

  • cryotherapy
  • neoplasm metastasis
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

The efficacy and complications of salvage cryotherapy of the prostate. / Pisters, Louis L.; Von Eschenbach, Andrew C.; Scott, Shellie M.; Swanson, David A.; Dinney, Colin P.N.; Pettaway, Curtis A.; Babaian, R. Joseph.

In: Journal of Urology, Vol. 157, No. 3, 03.1997, p. 921-925.

Research output: Contribution to journalArticle

Pisters, Louis L. ; Von Eschenbach, Andrew C. ; Scott, Shellie M. ; Swanson, David A. ; Dinney, Colin P.N. ; Pettaway, Curtis A. ; Babaian, R. Joseph. / The efficacy and complications of salvage cryotherapy of the prostate. In: Journal of Urology. 1997 ; Vol. 157, No. 3. pp. 921-925.
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abstract = "Purpose: A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full close radiation therapy and/or systemic therapy. The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen (PSA) levels and prostate biopsies as end points. Materials and Methods: A total of 150 patients with locally recurrent prostate cancer following radiation, hormonal therapy and/or systemic chemotherapy underwent salvage cryotherapy using a single (71 men, mean follow up 17.3 months) or double (79 men, mean follow up 10.0 months) freeze-thaw cycle. PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively. Complications were assessed by retrospective chart review and a mailed quality of life survey. Results: Overall, 45 patients (31{\%}) had persistently undetectable PSA. Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate (93 versus 71{\%}, p <0.02) and lower biochemical failure rate (defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value, 44 versus 65{\%}, p <0.03) than those who underwent a single freeze-thaw cycle. The main complications of salvage cryotherapy were urinary incontinence (73{\%} of the patients), obstructive symptoms (67{\%}), impotence (72{\%}) and severe perineal pain (8{\%}). Conclusions: Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies. A double freeze-thaw cycle appears more effective than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes significant morbidity.",
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AU - Scott, Shellie M.

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AU - Dinney, Colin P.N.

AU - Pettaway, Curtis A.

AU - Babaian, R. Joseph

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N2 - Purpose: A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full close radiation therapy and/or systemic therapy. The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen (PSA) levels and prostate biopsies as end points. Materials and Methods: A total of 150 patients with locally recurrent prostate cancer following radiation, hormonal therapy and/or systemic chemotherapy underwent salvage cryotherapy using a single (71 men, mean follow up 17.3 months) or double (79 men, mean follow up 10.0 months) freeze-thaw cycle. PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively. Complications were assessed by retrospective chart review and a mailed quality of life survey. Results: Overall, 45 patients (31%) had persistently undetectable PSA. Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate (93 versus 71%, p <0.02) and lower biochemical failure rate (defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value, 44 versus 65%, p <0.03) than those who underwent a single freeze-thaw cycle. The main complications of salvage cryotherapy were urinary incontinence (73% of the patients), obstructive symptoms (67%), impotence (72%) and severe perineal pain (8%). Conclusions: Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies. A double freeze-thaw cycle appears more effective than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes significant morbidity.

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