PERCUTANEOUS, TRANSPERINEAL CRYOSURGERY OF THE PROSTATE AS SALVAGE THERAPY FOR POST RADIATION RECURRENCE OF ADENOCARCINOMA

BACKGROUND, Surgical techniques utilizing the application of very low temperatures to malignant tissues have been used increasingly in recen t years in the minimally invasive treatment of prostate cancer. An are a of potential application appears to be in the management of radiatio n resistant prostate cancer. METHODS, This study represents a retrospe ctive chart review of 33 patients undergoing cryosurgical ablation of the prostate (CSAP) according to a protocol designed by an institution al review board at a single institution for the treatment of radiation resistant prostate cancer. Radiation resistance was defined as a posi tive prostate needle biopsy and rising prostate specific antigen (PSA) . Treatment effect was assessed by serial post treatment PSA determina tions and extensive systematic post treatment prostate needle biopsies . RESULTS, Of the 33 patients analyzed, 24 converted to an all negativ e biopsy status after one CSAP treatment. Repeat treatment converted t wo additional patients to a biopsy negative status. CSAP appeared to l ower PSA dramatically in most patients. One year after treatment, of 1 0 patients not on androgen deprivation therapy, 3 maintained a PSA of < 0.4 ng/mL and those patients with androgen deprivation therapy maint ained a PSA of < 4.0 ng/mL. The most frequent complications included s loughing syndrome (15.4%) and incontinence (10.3%). CONCLUSIONS, CSAP appears to eliminate biopsy detectable prostate tumor effectively in t he majority of cases in the salvage setting following radiation therap y. A significant discrepancy exists, however, between the biopsy ''cur e'' rate and the biochemical ''cure'' rate, even in the short term. Th ere is a suggestion that early detection of radiation failure map impr ove results of this salvage therapy. (C) 1996 American Cancer Society.