Focal cryotherapy in the treatment of localized prostate cancer

A recent article in Expert Review of Anticancer Therapy has assessed the effectiveness and safety of focal cryotherapy in the first- and second-line treatment of localized prostate cancer.

Shah et al. identified a total of nine published reports of outcomes from the first-line treatment of men using salvage cryotherapy and another two papers providing data related to second-line treatment of radiorecurrent prostate cancer. Here are their findings:

  • The database included 1,582 patients who were treated with first-line focal cryotherapy.
    • Follow-up for these men ranged from 9 to 70 months.
    • The biochemical disease-free survival rate during follow-up ranged from 71 to 93 percent across the nine published studies.
    • Post-treatment incontinence rates ranged from 0.0 to 3.6 percent.
    • Post-treatment rates of erectile dysfunction ranged from 0.0 to 42.0 percent.
    • Recto-urethral fistula was observed in 2/1,582 patients.
  • The number of patients treated for radiorecurrent disease is not listed in the paper’s abstract.
    • The biochemical disease-free survival rate for men treated for radiorecurrent disease ranged from 50 to 68 percent at 3 years of follow-up.
    • Post-treatment rates of erectile dysfunction ranged from 60 to 71 percent in men treated for radiorecurrent disease.

The authors conclude that:

Focal cryotherapy appears to be an effective treatment for primary localized prostate cancer and compares favorably to radical/whole gland treatments in medium-term oncological outcomes and side effects. Although more studies are needed it is also effective for radiorecurrent cancer with a low complication rates.

The “New” Prostate Cancer InfoLink would note that patients who want to consider focal cryotherapy as either a first- or a second-line form of treatment for prostate cancer should be aware that there are significant criteria that need to be met for a patient to be a good candidate for this type of treatment, and that these selection criteria are likely to vary among the small number of centers with real experience in the treatment of patients using this approach. Those criteria are likely to include:

  • Localization of tumor to one of more highly defined areas of the prostate (defined by specialized imaging techniques and targeted or saturation biopsies)
  • Overall extent and volume of tumor
  • The patient’s PSA level and Gleason score

Other factors (e.g., the patient’s biological “age” and state of health) are also important.

Patients considering focal cryotherapy as an option should also be aware that there really is a very small number of physicians (worldwide) who have significant experience in the conduct of focal cryotherapy, and that the experience and skill of the practitioner is very important to patients’ outcomes after focal cryotherapy. It is also unclear, here in the USA, whether such treatment will be covered by all health insurance providers.

The entire November 2014 issue of Expert Review of Anticancer Therapy was focused on issues specific to prostate cancer — for those readers who may want to look through the content and the abstracts.

3 Responses

  1. I think there is nothing to conclude without knowing the nature of the populations treated as you point out. It is entirely possible that a good percentage of these men just needed active surveillance. I was treated at one of the academic medical centers with cryoablation as a salvage therapy post-radiation (10 years out) to no avail. If the prostate cancer has already spread but was not easily found, it is a waste of time and money. We still need better testing and imaging techniques.

  2. Do bad results get published (incontinence, kidney infection, permanent catheterization, for example)? Where can a list of experienced doctors be found?

  3. Dear Ms. or Mr. Torode:

    You’d need to look at the details of the nine papers reviewed by Shah et al. to be able to tell exactly what those original papers reported in terms of “bad results”.

    I am not aware of any reliable list of individual physicians who are considered to have high expertise in the practice of focal cryotherapy for prostate cancer. I do know that there can’t be many of them.

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