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.