by Robert Fay

Percutaneous cryosurgery appears to be a viable treatment option for prostate cancer, according to a study published in the March 2008 issue of Urology. The authors say that the current study represents the "largest experience with the longest follow-up to date."

According to the authors, although prostate cryosurgery has been increasingly used for the management of localized prostate cancer since the introduction of the minimally invasive form of the procedure in the 1990s, concerns remain regarding its long-term efficacy. The current study sought to investigate this, focusing on the determination of biochemical disease-free survival for a group of patients with T1 to T3 prostate cancer who had undergone prostate cryosurgery as primary monotherapy.

The researchers retrospectively reviewed the records of 370 patients who were treated consecutively between March 26, 1991 and September 26, 1996 at Allegheny General Hospital. Only patients with no previous radiotherapy, hormone therapy, or surgery were included. Subjects were stratified into groups according to their risk:

• Low-risk — prostate specific antigen (PSA) level less than 10 nanograms per deciliter (ng/dL), Gleason score less than 7, and Stage T1;
• Moderate-risk — PSA 10 to 20 ng/dL, Gleason score 7, Stage T2, with other risk factors being low-risk; and
• High-risk — PSA more than 20 ng/dL, Gleason score of 8 to 10, Stage T3, or any two increased risk factors).

After a median follow-up of 12.5 years, the 10-year biochemical disease-free survival rate was 80.56 percent, 74.16 percent, and 45.54 percent for low-, moderate-, and high-risk patients, respectively. The 10-year negative biopsy rate was 76.96 percent.

Although more research needs to be done, the authors write that the "long-term rates of biochemical control with this modality using the nadir plus 2 ng/dL definition of biochemical control appeared to be within the ranges reported for contemporaneously treated patients using external beam radiotherapy or prostate brachytherapy as monotherapy. We expect with additional analysis to examine the issues of long-term disease-specific survival and the clinical outcomes of patients in the biochemically disease-free group and the biochemical failure group."

"The 10-year results (mean follow up 12.5 years) for cryosurgery are now established and provide a means of comparison to other treatment options," said Jeffrey K. Cohen, MD, study co-author, President of the Triangle Urological Group, and Chair, Urology Domain. "The results presented in this study clearly show that the PSA results attained with cryosurgery are comparable to surgery, brachytherapy, or external beam for low and intermediate risk. In the highest risk disease, the success rate at 10 years is impressive."

Noting that the study population was the group initially treated with one freeze with liquid nitrogen as the cryogen, Cohen continued, "Since that time, the procedures and equipment have markedly improved. Future data will most likely be better than what is presented in this study. Cryosurgery is as effective as any other treatment for adenocarcinoma of the prostate and now has 12-year follow up. Any description of cryosurgery as experimental is mistaken."

NorthPoint Domain has pioneered the development of the Informed Clinical Care approach for specialty medical practices. NorthPoint Domain's physician-directed patient engagement tools, provided via a customized Internet-based platform, facilitate effective learning and efficient communication between patients and physicians. The flagship product, the Patient Literacy Center (PLC), is a specialty-focused online resource that includes articles about conditions, tests, and treatments, as well as information on how patients can improve their overall health through risk factor management. To learn more about NorthPoint Domain, please visit NorthPoint Domain.

Source: Cohen JK, Miller RJ, Jr., Ahmed S, et al. 2008. Ten-year biochemical disease control for patients with prostate cancer treated with cryosurgery as primary therapy. Urology 71:515-518.

This material cannot be reproduced in digital or printed form without the express consent of NorthPoint Domain, Inc. Unauthorized copying or distribution of NorthPoint Domain's Content is an infringement of the copyright holder's rights.