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Salvage Cryosurgery in Prostate Cancer
no reports comparing QoL before and after other local salvage therapies Summary
such as salvage radical prostatectomy or salvage brachytherapy. Thus, it Cryosurgery guided by US and temperature monitoring is an effective
is not possible to directly compare the QoL outcomes of the various therapy for recurrent localised prostate cancer after radiation therapy.
local salvage treatments. Refinements in the surgical technique and equipment have resulted in
significantly less morbidity than previously reported while maintaining
Cost to the Healthcare System durable PSA results. Salvage cryosurgery is a reasonable option for
There are limited data in terms of the costs of salvage cryosurgery to selective patients with locally recurrent prostate cancer, and should be
the healthcare system. The costs of salvage cryosurgery are similar strongly considered early for patients defined as radiation failures. n
to those of primary cryosurgery. Two studies evaluating the cost of
primary cryosurgery demonstrate that it is significantly less expensive
Aaron E Katz is an Associate Professor of Clinical
than either radical prostatectomy or external-beam radiotherapy. It is
Urology and Vice Chairman of Urology at Columbia
also important to consider how the costs of salvage cryosurgery University Medical Center. He is also Director of the
compare with the costs of alternative treatments. Patients with
Center for Holistic Urology, which performs basic
research and conducts clinical trials investigating the
biochemical recurrence after radiation therapy typically have a long
role of natural therapies within urology. Dr Katz is
lifespan. Even when the PSA doubling time is <12 months, recognised as an expert in the field of prostate
approximately 50% of patients will live for longer than five years after
cryosurgery. In the early 1990s he began
using cryosurgery to cure prostate cancers, and his
biochemical relapse.
pioneering work in advancing the technology helped Medicare approve of this
therapy for treating radiation-recurrent tumours. He has also applied cryosurgery
The costs of hormonal therapy are significant, and it is conceivable that
to the treatment of small kidney tumours, and performed the ablation both
percutaneously and laparascopically. Dr Katz also developed a novel blood test
salvage cryosurgery may actually save money by either eliminating or
that can detect small numbers of prostate cancer cells in the blood. The test,
delaying the need for hormonal therapy in some patients. There is an reverse transcription polymerase chain reaction (RT-PCR), was the first to allow
urgent need for careful economic modelling to assess the cost-
urological cancers to be staged using a molecular assay.
effectiveness of salvage cryosurgery relative to alternative treatments.
1. Radge H, Elgamal A-A, Snow PB, et al., Ten-year disease Successful Application of Cryosurgical Ablation of the Patterns of recurrence and cancer control, Urol Clin North
free survival after transperineal sonography-guided Prostate, Technol Cancer Res Treatment, 2007;6:97–110. Am, 1997;24:395.
Iodine-125 brachytherapy with or without 45-Gray 14. Long JP, Bahn D, Lee F, et al., Five-year retrospective, 26. Pisters LL, von Eschenbach AC, Scott SM, et al., The
external beam irradiation in the treatment of patients multi-institutional pooled analysis of cancer-related efficacy and complications of salvage cryotherapy of the
with clinically localized, low to high Gleason grade outcomes after cryosurgical ablation of the prostate, prostate, J Urol, 1997;157:921.
prostate carcinoma, Cancer, 1998;83:989–1001. Urology, 2001;57:518–23. 27. Bales GT, Williams MJ, Sinner M, et al., Short-term
2. Stock RG, Stone NN, DeWyngaert JK, et al., Prostate- 15. Prepelica KL, Okeke Z, Murphy A, Katz AE, Cryosurgical outcomes after cryosurgical ablation of the prostate in
specific antigen findings and biopsy results following ablation of the prostate: high risk patient outcomes, men with recurrent prostate carcinoma following
interactive ultrasound guided transperineal Cancer, 2005:103:1625–30. radiation therapy, Urology, 1995;46:676.
brachytherapy for early stage prostate carcinoma, Cancer, 16. Bahn DK, Lee F, Badalament R, et al., Targeted 28. Cespedes RP, von Eschenbach LL, McGuire AC, Long-term
1996;77:2386–92. cryoablation of the prostate: seven-year outcomes in the follow-up of incontinence and obstruction after salvage
3. Zelefsky MJ, Leibel SA, Gaudin PB, et al. Dose escalation primary treatment of prostate cancer, Urology, 2002:60: cryosurgical ablation of the prostate: results in 143
with three-dimensional conformal radiation therapy 3–11. patients, J Urol, 1997;157:237.
affects the outcome of prostate cancer, Int Radiat Oncol Biol 17. Stock RG, Stone NN, Cesaretti JA, Prostate-specific 29. Bahn DK, Lee F, Silverman P, et al., Salvage cryosurgery
Phys, 1998;41:491–500. antigen bounce after prostate seed implantation for for recurrent prostate cancer after radiation therapy: a
4. Dinges S, Deger S, Koswig S, et al., High-dose rate localized prostate cancer: descriptions and implications, seven-year follow-up, Clin Prostate Cancer, 2003;2:111.
interstitial with external beam irradiation for localized Int J Radiat Oncol Biol Phys, 2003;56:448. 30. de la Taille A, Hayek O, Benson MC, et al., Salvage
prostate cancer-results of a prospective trial, Radiother 18. Rosser CJ, Kuban DA, Levy LB, et al., Prostate specific cryotherapy for recurrent prostate cancer after radiation
Oncol, 1998;48:197–202. antigen bounce phenomenon after external beam therapy: the Columbia experience, Urology, 2000;55:79.
5. Crook JM, Bunting PS, Percent free prostate-specific radiation for clinically localized prostate cancer, J Urol, 31. Ghafar MA, Johnson CW, De La Taille A, et al., Salvage
antigen after radiotherapy for prostate cancer, Urology, 2002;168:2001. cryotherapy using an argon based system for locally
1998;52:100–105. 19. Spiess PE, et al., Presalvage prostate-specific antigen recurrent prostate cancer after radiation therapy, J Urol,
6. Babaiain RJ, Kojima M, Saitoh M, et al., Detection of (PSA) and PSA doubling time as predictors of biochemical 2001;166:1333.
residual prostate cancer after external radiotherapy, failure of salvage cryotherapy in patients with locally 32. Chin JL, Pautler SE, Mouraviev, et al., Results of salvage
Cancer, 1996;75:2153–8. recurrent prostate cancer after radiotherapy, Cancer, cryoablation of the prostate after radiation: identifying
7. Laverdiere J, Gomez JL, Cusan L, et al., Beneficial effect of 2006;107(2):275–80. predictors of treatment failure and complications, J Urol,
combining hormonal therapy administered prior and 20. Sartor CI, Strawderman MH, Lin XH, et al., Rate of PSA 2001;165:1937.
following external beam radiation therapy for localized rise predicts metastatic versus local recurrence after 33. Cresswell J, Asterling S, Chaudhary M, et al., Third-
prostate cancer, Int J Radiat Oncol Biol Phys, 1997;37:247–52. definitive radiotherapy, Int J Radiat Oncol Biol Phys, 1997;38: generation cryotherapy for prostate cancer in the UK: a
8. Ljung G, Norberg M, Hansson H, et al., Transrectal 941. prospective study of the early outcomes in primary and
ultrasonically-guided core biopsies in the assessment of 21. Crook JM, Bahadur YA, Robertson SJ, et al., Evaluation of recurrent disease, BJU Int, 2006;97:969.
local cure of Prostatic cancer after radical external beam radiation effect, tumor differentiation, and prostate 34. Han KR, Belldegrum AS., Third-generation cryosurgery for
radiotherapy, Acta Oncologica, 1995;34:945–52. specific antigen staining in sequential prostate biopsies primary and recurrent prostate cancer, BJU Int, 2004;93:14.
9. Roach M 3rd, Hanks G, Thames H Jr, et al., Defining after external beam radiotherapy for patients with 35. Donnelly BJ, Saliken JC, Ernst DS, et al., Role of transrectal
biochemical failure following radiotherapy with or without prostate carcinoma, Cancer, 1997;79:81. ultrasound guided salvage cryosurgery for recurrent
hormonal therapy in men with clinically localized prostate 22. Eichler, et al., Diagnostic value of systematic biopsy prostate carcinoma after radiotherapy, Prostate Cancer
cancer: recommendations of the RTOG-ASTRO Phoenix methods in the investigation of prostate cancer: a Prostatic Diseases, 2005;8:235–42.
Consensus Conference, Int J Radiat Oncol Biol Phys, 2006;65: systematic review, J Urol, 2006:175(5):1605–12. 36. Robinson JW, Donnelly BJ, Coupland K, et al., Quality of
965. 23. Gheiler EL, Tefilli MV, Tiguert R, et al., Predictors for life two years after salvage cryosurgery for the treatment
10. Crook J, Malone S, Perry G, et al., Post-radiotherapy maximal outcome in patients undergoing salvage surgery of local recurrence of prostate cancer after radiotherapy,
prostate biopsies: what do they really mean? Results for for radio-recurrent prostate cancer, Urology, 1998;51:789. Urologic Oncology, 2006;24:472–86.
498 patients, Int J Radiat Oncol Biol Phys, 2000;48:355. 24. Chin JL, Pautler SE, Mouraviev V, et al., Results of salvage 37. Anastasiadis AG, Sachdev R, Salomon L, Katz AE,
11. Baust JG, Gage AA, The Molecular Basis of Cryosurgery, cryoablation of the prostate after radiation: identifying Comparison of health-related quality of life and prostate-
BJU Int, 2005;95:1187–91. predictors of treatment failure and complications, J Urol, associated symptoms after primary and salvage
12. Hoffmann NE, Bischof JC, The cryobiology of cryosurgical 2001;165:1937. cryotherapy for prostate cancer, J Cancer Res Clin Oncol,
injury, Urology, 2002;60:40–49. 25. Pound CR, Partin AW, Epstein JI, et al., Prostate-specific 2003;129:676–82.
13. Baust JG, Gage AA, Klossner D, et al., Critical Issues in the antigen after anatomic radical retropubic prostatectomy.
EUROPEAN UROLOGICAL REVIEW 23
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