F. Lee et al., CRYOSURGERY OF PROSTATE-CANCER - USE OF ADJUVANT HORMONAL-THERAPY ANDTEMPERATURE MONITORING - A ONE-YEAR FOLLOW-UP, Anticancer research, 17(3A), 1997, pp. 1511-1515
Objective: To determine the clinical outcomes at one year of Stages T2
-T3 prostate cancer by cryosurgery utilizing pretreatment with total a
ndrogen ablation therapy and temperature monitoring to control the fre
ezing process. Study Group: To date, 347 patients have had 356 cryosur
gical procedures. 280 have reached one year post treatment Of these, 1
31 had re-evaluation with prostatic biopsy and serum PSA. Methods: Tra
nsrectal ultrasound (TRUS) measurement of tumor size and biopsy of ext
raprostatic space was used to stage patients into two main groups: con
fined (66.6%) versus nonconfined (19.3%). Radiation failures (14.1%) f
ormed a separate group. Failure rates for the 131 men include all canc
er diagnosed during the one year period following cryosurgery. Results
: The one year failure rate for the study group was 19.8% (26/131). Fo
r stages T2a, T2b C, T3 and radiation failures, the rates of positive
biopsies were 13.9%, 12.9%, 33.3% and 35%, respectively. For those wit
h local control of cancer (negative biopsy), 80% had prostate specific
antigen (PSA) levels of < 0.5 ng/ml. The statistical variables for pe
rsistent cancer with prostate specific antigen > 0.5 ng/ml were: sensi
tivity of 66.7%, PPV of 16.7%, NPV of 98% and specificity of 83.7%. A
statistically significant difference exists between stages T2 vs T3 an
d radiation failures (p = < 0.5). Major complications of rectal fistul
a and total incontinence for previously non-treated cancer versus radi
ation failures were 0.33% and 8.7% respectively a 26 times greater ris
k. Conclusion: Results of cryosurgery for all stages of prostate cance
r at one year are encouraging being 80% free of disease (biopsy and pr
ostate specific antigen). The morbidity of the previously non-treated
cancers from this procedure for us was minimal with high patient accep
tance. For radiation failures a local control rate of 65% was achieved
. However, early in our experience significant morbidity did occur and
our enthusiasm for attempted salvage was initially tempered.