Outcomes of primary cryotherapy for prostate cancer

In the February 2007 issue of Urology, Dr. Ellis from the Urology Associates of North Texas reports on a large series of patients treated with primary cryotherapy for prostate cancer (CaP).

From 2000 to 2005, 416 patients underwent cryoablation for localized CaP using the Cryocare System with a urethral warming catheter. Most patients were discharged home the day of treatment and had a voiding trial 6 to 7 days post-procedure. Patients potent at intervention used a vacuum therapy devise and advised to maintain an erection for 5 minutes at least once daily beginning 6 weeks after cryoablation. They also took a PDE-5 inhibitor every other day beginning 6 months after therapy. Incontinence and impotence were assessed by physician interviews beginning at 6 months. Only patients continent and potent at intervention were included in the post-treatment analysis.

The mean follow-up was 20 months. A total of 4% of patients who were continent pre-procedure were incontinent after therapy. A total of 39% of patients reported being potent pre-treatment and all men were impotent immediately after cryotherapy. The probability for a man potent prior to treatment to regain his ability to have intercourse with or without PDE-5 inhibitor assistance at 1, 2, and 4 years was 29%, 49%, and 51%, respectively. Nearly 80% of men achieved a PSA nadir of less than 0.4ng/mlwith a 4-year biochemical freedom from disease rate of 80%. In those experiencing disease failures, the mean time to failure was 4.2 months. Of 168 patients who underwent a prostate biopsy, 10% had CaP at a mean of 10 months after treatment.

Of note is that the standard accepted method of assessing patients' potency and continence outcomes is an anonymous patient survey, as physician interview assessment as performed in this study introduces bias. While there is no comparison made to other therapies, the potency rates reported in this study for a group of men with normal potency pre-procedure are lower that reports for other treatments.

David S. Ellis, Theodore B. Manny, Jr, and John C. Rewcastle

Urology 2007;69:306-310

By Christopher P. Evans, MD