10-year follow-up data on cryotherapy for prostate cancer

In a newly published report, a team of clinicians from Columbia University Medical Center has provided data on the 10-year follow-up of a small group of patients treated with salvage or primary cryotherapy for prostate cancer. They claim that this is the longest reported follow-up on patients treated with cryotherapy and the first reported 10-year outcome data.

Cheetham et al. carried out a retrospective chart review of patients in their cryotherapy database, and identified 76 men who had undergone prostate cryotherapy before January 1999.

Analysis of available data gave the following results:

  • The average (mean) age of the patients was 69.2 years, and ranged from 47.4 to 86.3.
  • The patient’s median preoperative PSA level was 5.3 ng/ml (range, 0.2 to 208.0 ng/ml) and their mean Gleason score was 7.
  • 40/76 patients (52.6 percent) were confirmed as meeting the D’Amico criteria for high risk.
  • 25/76 patients underwent primary treatment; and 51/76 patients had cryotherapy as salvage therapy after radiation therapy.
  • Median follow-up was 10.1 years (range, 0.2- to 14.9 years).
  • After 10 years of follow-up:
    • 43/76 men (56.6 percent) were still alive.
    • 33/76 men (43.4 percent) had died.
    • 10/33 men who died had dies from prostate cancer.
    • 18/33 men who died had died from noncancerous causes.
    • In 5/33 cases the cause of death was unknown.

The authors state that the long-term results of prostate cryotherapy in their series indicate an 87 percent prostate-cancer-specific survival at a median follow-up of 10 years, despite the fact that these patients were treated with relatively early cryotherapy technology and the fact that > 50 percent of these patients met D’Amico high-risk criteria. Overall survival at 10 years, however, was only 56.6 percent in this group of patients.

It is clear that cryotherapy can, in the hands of experienced clinicians, produce high rates of prostate cancer-specific survival — when used as primary therapy and when used in the salvage setting. However, it is unfortunate that this 10-year follow-up study (at least in the abstract) provides no information at all about these patients’ side effects and quality of life. Evolution of cryotherapy technology over the past decade has certainly improved the potential of this form of therapy to deliver long-term cancer-specific outcomes, but then so have other forms of therapy.

The optimal use of cryotherapy compared to other forms of treatment is still unknown, even though it is one of the few forms of treatment that has ever been subjected to a “head-to-head” trial (against external beam radiotherapy) in the primary treatment of prostate cancer. Based on data available at this time, so-called “complete gland” cryotherapy seems to offer the greatest potential in salvage therapy after first-line radiation treatment. The role of focal cryotherapy as a first-line treatment is still in the early stages of evolution.

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