SHORT-TERM OUTCOMES AFTER CRYOSURGICAL ABLATION OF THE PROSTATE IN MEN WITH RECURRENT PROSTATE CARCINOMA FOLLOWING RADIATION-THERAPY

Objectives. Cryosurgical ablation of the prostate represents a possibl y efficacious method of treating prostate carcinoma in men failing rad iation therapy. In addition to eradicating the disease, cryosurgery ha s the potential to avoid some of the morbidity associated with other t reatment modalities. Therefore, a prospective Phase II trial was condu cted to determine the safety and efficacy of cryosurgery following rad iation therapy in men with local recurrence. Methods. Cryosurgical abl ation of the prostate was performed in men with prostate cancer previo usly treated by radiation therapy. All patients had biopsy-proven recu rrent disease and no evidence of metastases. Initial follow-up occurre d at approximately 3 months and included repeat biopsy and serum prost ate-specific antigen (PSA) determinations. Biochemical disease-free su rvival defined as a PSA value less than 0.3 ng/mL was assessed using t he Kaplan-Meier method.Results. Thus far, 23 patients have been treate d with cryosurgery with follow-up ranging between 12 and 23 months, Ap proximately 3 months after treatment, sextant biopsies revealed no can cer in 19 of 22 (86%) of the specimens; however, 10 of 22 (45%) showed small amounts of benign glandular tissue, The PSA at 3 months postope ratively declined in 18 of 22 (82%) patients but reached female levels in only 8 men (36%). Nineteen of 22 (86%) patients followed up a mini mum of 1 year after cryotherapy have a PSA level equal to or greater t han 0.3 ng/mL. Complications occurred in 100% of the patients with 12 of 22 (55%) requiring at least one transurethral resection of sloughed , necrotic tissue. Conclusions. Our preliminary results suggest that t he current cryosurgical technique used in men failing radiation therap y has a low probability of biochemical cure and a high complication ra te, Until more data are available, cryosurgery for men with locally re current disease after radiation therapy should be considered strictly experimental.