CRYOSURGICAL ABLATION OF THE PROSTATE - 2-YEAR PROSTATE-SPECIFIC ANTIGEN AND BIOPSY RESULTS

Objectives. Percutaneous cryosurgical ablation of the prostate (CSAP) was performed on patients with localized or locally advanced adenocarc inoma of the prostate. To assess local disease control, post-treatment biopsy and serum prostate-specific antigen (PSA) levels were obtained at 3 and 24 months post-treatment. Methods. From June 1990 through Ma y 1994, CSAP was performed 448 times on 383 patients under Institution al Review Board protocols, A urethral warming catheter was used for al l procedures. A total of 239 patients were followed for a minimum of 2 1 months after treatment. None of this group had received prior local treatment. The group consisted of patients who were newly diagnosed an d treated solely with cryotherapy (virgin); the remainder had been on androgen deprivation therapy (ADT) prior to CSAP. Results. Biopsies we re obtained from 114 patients at 21 months or more after treatment. In the virgin group, 79% had a negative biopsy after one or more treatme nts, and 88% of the ADT group are negative after one or more treatment s. Overall, 69% had a negative biopsy after one treatment and 82% had a negative biopsy following one or more CSAP treatments. Of a group of 163 patients, PSA data were evaluable at 21 months or more after trea tment. In the virgin group, 60% had a PSA 0.4 ng/mL or less, and 77% h ad a PSA 1.0 ng/mL or less, In the ADT group, 40% had a PSA 0.4 ng/mL or less, and 69% had a PSA value of 1.0 ng/mL or less. Complications w ere minimal, the most common one being urethral tissue sloughing, whic h occurred in 10% of patients. Conclusions. CSAP appears to be effecti ve in obtaining local control as measured by biopsy and PSA 21 months or more post-treatment. When retrospectively comparing our results wit h recently published radiotherapy series, CSAP was more effective in o btaining nadir PSA values 1.0 ng/mL or less and negative biopsies at 2 1 months or more after treatment.