After a median follow-up of nine months, prostate-specific antigen (PSA) levels fell to less than 0.5 ng/mL in 79% of patients who underwent cryotherapy for primary treatment of prostate cancer (n = 31) and in 67% of those undergoing salvage cryotherapy after radiotherapy or hormone ablation (n = 20).
Higher Gleason grade and PSA levels before cryotherapy were associated with a poorer outcome. No patient developed a fistula, a common complication with first-generation cryotherapy. Four percent of patients developed urinary retention necessitating transurethral prostatectomy and 4% had persistent incontinence.
Rates of erectile dysfunction were high (86%) and patients "should be counseled" about this complication, advise Dr. Joanne Cresswell and colleagues from Sunderland Royal Hospital in the May issue of BJU International.
Modern, third-generation cryotherapy now involves transrectal ultrasound guidance, urethral warming catheters, and temperature warming probes as well as small gas-based probes.
"Advantages include a shorter hospital stay and lower morbidity than for radical surgery, therefore allowing consideration of older and less fit patients who seek curative therapy," concludes the U.K. team.
They caution that the current data are based on short follow up. Longer follow-up is needed to determine the "durability of response and therefore the probability of cure," Dr. Cresswell and colleagues note.
Last Updated: 2006-05-31 17:22:32 -0400 (Reuters Health)
BJU Int 2006;97:965-974.
Low-grade prostate cancer may not require aggressive treatment, May 26, 2006
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