Outcomes of Cryotherapy for Prostate Cancer

Outcomes of Cryotherapy for Prostate Cancer

Written by Christopher P. Evans, MD
Thursday, 19 April 2007

BERKELEY, CA (UroToday . com ) - In the February 2007 issue of Urology,
Dr. Ellis from the Urology Associates of North Texas reports on a
large series of patients treated with primary cryotherapy for prostate
cancer (CaP).

From 2000 to 2005, 416 patients underwent cryoablation for localized
CaP using the Cryocare System with a urethral warming catheter. Most
patients were discharged home the day of treatment and had a voiding
trial 6 to 7 days post-procedure. Patients potent at intervention used
a vacuum therapy devise and advised to maintain an erection for 5
minutes at least once daily beginning 6 weeks after cryoablation. They
also took a PDE-5 inhibitor every other day beginning 6 months after
therapy. Incontinence and impotence were assessed by physician
interviews beginning at 6 months. Only patients continent and potent
at intervention were included in the post-treatment analysis.

The mean follow-up was 20 months. A total of 4% of patients who were
continent pre-procedure were incontinent after therapy. A total of 39%
of patients reported being potent pre-treatment and all men were
impotent immediately after cryotherapy. The probability for a man
potent prior to treatment to regain his ability to have intercourse
with or without PDE-5 inhibitor assistance at 1, 2, and 4 years was
29%, 49%, and 51%, respectively. Nearly 80% of men achieved a PSA
nadir of less than 0.4ng/mlwith a 4-year biochemical freedom from
disease rate of 80%. In those experiencing disease failures, the mean
time to failure was 4.2 months. Of 168 patients who underwent a
prostate biopsy, 10% had CaP at a mean of 10 months after treatment.

Of note is that the standard accepted method of assessing patients'
potency and continence outcomes is an anonymous patient survey, as
physician interview assessment as performed in this study introduces
bias. While there is no comparison made to other therapies, the
potency rates reported in this study for a group of men with normal
potency pre-procedure are lower that reports for other treatments.

David S. Ellis, Theodore B. Manny, Jr, and John C. Rewcastle

Urology 2007;69:306-310

doi:10.1016/j.urology.2006.10.024

UroToday . com Prostate Cancer Section

Excerpted from

Outcomes of Cryotherapy for Prostate Cancer
< * w w w .urotoday . com /61/browse_categories/prostate_cancer/outcomes_of_cryotherapy_for_prostate_cancer.html>


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Matti Narkia

Hi Matti...Why did you post this article? What point that they were
making did you find of value? Most men will select a PCa treatment
based on its ability to eradicate the cancer. This excerpt did not
describe cancer charcateristics of the men studied, nor did it say
what the definition of failure was. The mean (that didn't even use
the accepted "median") follow-up was exceedingly short (studies
addressing disease feedom need at least 60 months) lessening the
accuracy of their projected 40 month bNED. Hence their analysis of
the curative efficacy of cryo is extremely lacking. So again, what
was it you wanted us to be aware of? That most men suffer ED after
cryo? That's certainly not news.

Cryo can be a useful treatment for elderly men or men with other co-
morbidities. It can also be used to treat recurrences. None of those
uses were at the center of this study. Just what was the point?..Best
wishes and good health, ron

On 19 Apr 2007 13:33:31 -0700, ron <oitbso@yahoo . com > wrote:

>Hi Matti...Why did you post this article?

One reason was to get feedback, thank you for that ;-). I don't have
PCa (to my knowledge, knocking on the wood), so I'm not as familiar
with its treatments as I'd like to be. Sometimes posting a study will
prompt educated replies like yours, which may benefit me and others.

>What point that they were
>making did you find of value? Most men will select a PCa treatment
>based on its ability to eradicate the cancer. This excerpt did not
>describe cancer charcateristics of the men studied, nor did it say
>what the definition of failure was. The mean (that didn't even use
>the accepted "median") follow-up was exceedingly short (studies
>addressing disease feedom need at least 60 months) lessening the
>accuracy of their projected 40 month bNED. Hence their analysis of
>the curative efficacy of cryo is extremely lacking. So again, what
>was it you wanted us to be aware of? That most men suffer ED after
>cryo? That's certainly not news.
>
I recently posted this news article

Cryotherapy Endorsed By The European Association Of Urology For
Treatment Of Prostate Cancer
April 4, 2007
< * w w w .cancercompass . com /cancer-news/1,12433,00.htm?rss=y>

partly, because here in Finland cryotherapy has been done mainly in
one hospital only, which is not in capital Helsinki, and I've seen
some remarks about its adverse effects in the Finnish PCa treatment
guidelines although in unsatisfactory detail. However, I didn't get
any feedback from that message.

I'm sure that there are a lot of good studies out there describing
pros and cons in great detail, but I have not yet been in the
situation where I would have had reason and time to search for them.
So perhaps at least part of what I wished was to get some kind of
assessment about the cryotherapy vs. other therapies. And you have
provided some of that, thanks for it :-).

>Cryo can be a useful treatment for elderly men or men with other co-
>morbidities. It can also be used to treat recurrences. None of those
>uses were at the center of this study. Just what was the point?..Best
>wishes and good health, ron
>
That's something that I wished for, an assessment of applicability.
Thanks.

Best wishes and good health to you, too.



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Matti Narkia