Duke K. Bahn, M.D.
Department of Radiology, Crittenton Hospital, Rochester, MI
Editors Note:I feel it is appropriate to state that Dr Bahn is both a colleague and professional associate of mine.
Introducton: Presently there are several treatment options for prostate cancer. When the cancer is confined within the prostate, watchful waiting, androgen ablation therapy, radical prostatectomy and radiation therapy are the common treatments of choice. A controlled freezing process of the prostate called cryosurgery is now being offered as an alternative to these traditional treatments. Cryosurgery has been used for many years in the treatment of skin cancers. This technology is now being utilized in the treatment of cancers of the liver, prostate, pancreas and kidney . Cryosurgery is less invasive than tradition surgery and seems to associated with fewer complications. It can be done as an outpatient procedure, but usually the patients are admitted to the hospital for one night. During the last three years over 500 patients have been treated with cryosurgery at Crittenton Hospital in Rochester, Michigan. The results of this work was presented at an international conference ( The Radiological Society of North America) in Chicago in December 1996.
Results : Patients with prostate cancer were divided into three groups. The first group had cancer confined to the prostate. These patients are usually a candidate for radical surgery. Up to three years follow up after cryosurgery showed 10 % positive biopsy rate (failure) compared to 40 - 50 % positive surgical margin rate (eventual failure) with radical prostatectomy and 35 - 90 % positive biopsy rate after radiation therapy (1,2,3,4,5).
The second group were patients whose cancer had already spread outside of the prostate capsule, but did not have distant metastasis (non-confined, stage C disease ). These patients usually are not recommeded for radical surgery. In general they have had poor out-comes with traditional treatments. In this group, the reported failure rate after cryosurgery was 26 % in this series.
The third group were patients who had
failed radiation therapy prior to having cryosurgery. Our data showed a
25 % failure rate in this category.
|Positive Biopsy||Failure rate|
Out of 279 patients
28 had a Positve biopsy
|All Patients||57/392||14.5 %|
Discussion: Although cryosurgery seems to offer promise in the treatment of prostate cancer it is not without risk. We conducted an outcome study utilizing a survey form which was mailed directly to the patients. These were filled out annonymously. The incontinence rate was reported at 8 % by the cryosurgery patients. This compares to published reports of 30 % and 11 % with radical prostatectomy and radiation therapy respectively. Impotence is a major complication with all forms of treatment for prostate cancer. The cryosurgery patients reported a 85% incidence of impotence. Reported impotence rates after radical prostatectomy and radiation therapy are 89% and 84 % respectively (6,7). Another serious complication after cryosurgery is rectal fistula formation. It was 0.4 % in our series. These complications were seen most frequently in patients who had already been radiated prior to cryosurgery. The complication rate was highest in first 50 patients. This is likely due to the learning curve associated with this complex procedure.
Conclusion: Cryosurgery appears to be more effective than current standard treatment options. The complication rate was also lower in this series. It is also a promising modality in patients who are radiation therapy failures. Long term follow-up is still lacking with this proceedure. Unfortunately, it will take about five to ten year before we know the true efficacy of this treatment. A long term study is now in progress.
1. Zenke et al : J Urol 1994 : 152 : 1850 -7
2. Walsh et al : J Urol 152 : 1831 -6
3. Paulson et al : J Urol 1994 : 152 : 1826 -30
4. Miller et al : Urology April 1993 Vol. 41 No.
5. Badalament et al: Urol Oncol 1996 : 2 : 88-91
6. Fowler et al : Urology Dec. 1993 Vol. 42 No 6
7. Jonler et al : Urology Dec. 1994 Vol. 44 No 6
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