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Salvage Cryotherapy for Prostate Cancer Studied at M.D. Anderson

Salvage Cryotherapy for Prostate Cancer Studied at M.D. Anderson

ORLANDO--Treatment of recurrent prostate cancer, whether by prostatectomy
or chemotherapy, has not yielded very effective or long lasting
results. Many patients now ask about cryotherapy, in the hopes
of better effectiveness and/or improved quality of life (less
incontinence and less chance of impotence). However, urologists
have been reluctant to use salvage cryosurgery for prostate cancer
patients after radiation or hormonal therapy, because the outcome
and quality of life data were simply not there, Louis L. Pisters,
MD, said at the American Urological Association meeting earlier
this year.

Now, research from The University of Texas M.D. Anderson Cancer,
where Dr. Pisters is assistant professor of urology, has identified
a subset of patients likely to benefit from salvage cryotherapy,
although they would also likely be candidates for standard prostatectomy.

The study also provides some of the first data on complications
after salvage cryo-therapy from the patient's perspective, rather
than physician-directed questioning, he said.

Dr. Pisters and his colleagues reviewed their experience with
salvage cryotherapy in 145 patients treated between 1992 and 1995,
to define a group of patients most likely to show persistently
undetectable PSA levels after the procedure.

They considered several pretreatment factors as possible predictors
of biochemical recurrence: stage/grade at initial diagnosis, type
of prior therapy, stage/grade of local recurrence, number of positive
biopsy cores at recurrence, precryother-apy PSA, prior transurethral
resection of the prostate, and time interval between initial diagnosis
and recurrence.

Three factors were found to be important predictors of PSA recurrence:
pretreatment PSA, Gleason grade at the time of recurrence, and
time interval between initial diagnosis and recurrence. "A
PSA under 10 ng/mL in radiation failures and a PSA less than 5
ng/mL in patients failing hormonal therapy were associated with
a higher rate of PSA cure," he said.

In the group treated first with radiation, only one patient with
a PSA greater than 15 ng/mL did not have a biochemical recurrence
after salvage cryotherapy, while in those who failed hormonal
therapy, salvage cryotherapy did not achieve biochemical cure
in any patients with a pretreatment PSA greater than 5 ng/mL.

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