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Boissier R, Sanguedolce F, Territo A, Gaya JM, Huguet J, Rodriguez-Faba O, Regis F, Gallioli A, Vedovo F, Martinez C, Palou J, Breda A. Partial salvage cryoablation of the prostate for local recurrent prostate cancer after primary radiotherapy: Step-by-step technique and outcomes. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mantica G, Chierigo F, Suardi N, Gomez Rivas J, Kasivisvanathan V, Papalia R, Fiori C, Porpiglia F, Terrone C, Esperto F. Minimally invasive strategies for the treatment of prostate cancer recurrence after radiation therapy: a systematic review. MINERVA UROL NEFROL 2020; 72:563-578. [PMID: 32748617 DOI: 10.23736/s0393-2249.20.03783-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this review was to conduct a comprehensive analysis of the role of minimally invasive salvage modalities in radio-recurrent prostate cancer and the associated clinical outcomes and toxicity profiles. EVIDENCE ACQUISITION A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Scopus databases in January 2020. All papers published after 2000, concerning studies conducted on humans for radio-recurrent prostate cancer were considered for the review. EVIDENCE SYNTHESIS Overall, 545 studies were identified. After duplicate exclusion, initial screening, and eligibility evaluation, a total of 80 studies were included in the qualitative analysis, corresponding to a cohort of 6681 patients. The median age at initial diagnosis ranged from 59 to 75.5. Pre-treatment PSA ranged from 6.2 to 27.4 ng/mL. All patients underwent primary radiotherapy for localized prostate cancer. Cryotherapy, Brachytherapy, EBRT, HIFU were the minimally invasive options mostly used as salvage therapy. They showed to be promising approaches for recurrent prostate cancer (PCa) control, with acceptable toxicities. CONCLUSIONS Minimally invasive therapeutic options offer promising results in terms of biochemical control in the local recurrence setting. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish which method is the best in terms of oncological and safety outcomes.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Francesco Chierigo
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Nazareno Suardi
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid, Spain
| | - Veeru Kasivisvanathan
- UCL Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
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Ingrosso G, Becherini C, Lancia A, Caini S, Ost P, Francolini G, Høyer M, Bottero M, Bossi A, Zilli T, Scartoni D, Livi L, Santoni R, Giacomelli I, Detti B. Nonsurgical Salvage Local Therapies for Radiorecurrent Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2019; 3:183-197. [PMID: 31411996 DOI: 10.1016/j.euo.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT Different nonsurgical therapeutic strategies can be adopted for intraprostatic relapse of prostate cancer after primary radiotherapy, including re-irradiation (with brachytherapy [BT] or external beam radiotherapy [EBRT]), high-intensity focused ultrasound (HIFU), and cryotherapy. The main issues to consider when choosing nonsurgical salvage local therapies are local tumor control and significant genitourinary toxicity. OBJECTIVE To conduct a systematic review and meta-analysis of the role of nonsurgical salvage modalities in patients with radiorecurrent prostate cancer and associated clinical outcomes and toxicity profiles. EVIDENCE ACQUISITION We performed a critical review of the Medline, Scopus, and ClinicalKey databases from January 1, 2000 through February 1, 2018 according to the Preferred Reporting Items and Meta-Analyses statement. To assess the overall quality of the literature reviewed, we used a modified Delphi tool for case-series studies. EVIDENCE SYNTHESIS A total of 64 case-series studies were included, corresponding to a cohort of 5585 patients. The modified Delphi checklist evidenced high methodological quality overall (mean quality score of 80.6%). Biochemical control rates were lowest for patients treated with HIFU (58%, 95% confidence interval [CI] 47-68%) and highest for patients treated with BT (69%, 95% CI 62-76%) and EBRT (69%, 95% CI 53-83%). The lowest prevalence of incontinence was for patients treated with BT (3%, 95% CI 0-6%; I2=63.4%) and the highest was among patients treated with HIFU (28%, 95% CI 19-38%; I2=89.7%). CONCLUSIONS Nonsurgical therapeutic options, especially BT, showed good outcomes in terms of biochemical control and tolerability in the local recurrence setting. PATIENT SUMMARY The current analysis demonstrated that nonsurgical salvage local therapies offer a chance of a curative local approach in radiorecurrent prostate cancer. However, high-quality data from prospective trials are needed to validate long-term outcomes from nonsurgical strategies for the treatment of intraprostatic recurrence after previous radiotherapy.
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Affiliation(s)
- Gianluca Ingrosso
- Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Carlotta Becherini
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
| | - Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Networking, Florence, Italy
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Giulio Francolini
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
| | - Morten Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Marta Bottero
- Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Alberto Bossi
- Department of Radiotherapy, Gustave-Roussy Institute, Villejuif, France
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Daniele Scartoni
- Proton Treatment Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
| | - Riccardo Santoni
- Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Irene Giacomelli
- Proton Treatment Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Beatrice Detti
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
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Crouzet S, Blana A, Murat FJ, Pasticier G, Brown SCW, Conti GN, Ganzer R, Chapet O, Gelet A, Chaussy CG, Robertson CN, Thuroff S, Ward JF. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. BJU Int 2017; 119:896-904. [PMID: 28063191 DOI: 10.1111/bju.13766] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database. PATIENTS AND METHODS This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported. RESULTS In all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4-10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group. CONCLUSION S-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of >80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure.
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Affiliation(s)
| | - Andreas Blana
- Department of Urology, Fuerth Hospital, Fürth, Germany
| | | | | | | | | | - Roman Ganzer
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Olivier Chapet
- Department of Radiation Oncology, Lyon Sud Hospital, Pierre Bénite, France
| | - Albert Gelet
- Department of Urology, Edouard Herriot Hospital, Lyon, France
| | | | | | - Stefan Thuroff
- Department of Urology, Harlaching Hospital, Munich, Germany
| | - John F Ward
- Department of Urology, M. D. Anderson Cancer Center, Houston, TX, USA
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Chin JL, Touma N. Current Status of Salvage Cryoablation for Prostate Cancer following Radiation Failure. Technol Cancer Res Treat 2016; 4:211-6. [PMID: 15773790 DOI: 10.1177/153303460500400210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The role of salvage cryoablation of the prostate for patients with clinically localized prostate cancer that have failed radiotherapy to the prostate is reviewed with reference to alternatives including salvage radical prostatectomy and brachytherapy. The diagnosis and work-up of local recurrence/persistence of cancer in the prostate are reviewed and the patient selection criteria for salvage cryoablation is discussed. Technical aspects of the cryoablation procedure along with the outcome in terms of cancer control and treatment-related complications are detailed. The five-year biochemical disease-free rate is approximately 40%. The complication rate is acceptable. Salvage cryoablation definitely has a role in the management of localized prostate cancer treatment failure following radiotherapy, especially in older patients and those with some comorbidities.
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Affiliation(s)
- Joseph L Chin
- Division of Urology, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 4G5, Canada.
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Abstract
Cryosurgery, a method of treating disease by the production of freezing temperatures in the tissue, is a useful technique for the treatment of tumors. When the modern era of cryosurgery began in the mid 1960's, the technique was used only for tumors easily accessible by direct observation or via endoscopy, such as those of the skin, oral cavity, and prostate gland. In general, the technique had limited usefulness in the next two decades. However, with the advent of intraoperative ultrasound as a method of monitoring the process of freezing and with the development of more effective cryosurgical apparatus, the cryosurgical treatment of tumors of the viscera and other deep tissues became practical in the 1990's. This review assesses the present day status of cryosurgery in the management of diverse tumors.
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Affiliation(s)
- Andrew A Gage
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 14214, USA.
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Griffin RJ, Williams BW, Roberts KP, Swanlund DJ, Bischof JC. Assessing pH and Oxygenation in Cryotherapy-induced Cytotoxicity and Tissue Response to Freezing. Technol Cancer Res Treat 2016; 3:245-51. [PMID: 15161317 DOI: 10.1177/153303460400300302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The microenvironmental pH and oxygenation is known to influence tumor cell response to heat, radiation, photodynamic and even chemotherapy. We have studied the previously untested influence of acidity and hypoxia on tumor and endothelial cell sensitivity to freezing. In addition, we have measured changes in oxygenation in vivo in murine FSaII fibrosarcomas after freeze injury. A low pH or low oxygenation environment was found to increase the sensitivity of tumor and endothelial cells to freezing at −20° C or −40° C in vitro. However, low pH and low oxygenation combined did not further increase cryosensitivity of the cells. In vivo, tumor oxygenation after freeze injury was studied immediately or 1–3 days after a standard freezing protocol was applied to FSaII tumors ranging from 250–500 mm3 grown in the rear-limb of C3H mice. Tumor oxygenation at the edge of the iceball was found to transiently increase 1–2 hours after freezing. At 1–3 days after freezing, a treatment that delayed FSaII tumor growth by approximately 1.5-fold, the mean tumor oxygenation was significantly increased by up to 2.5-fold from a control level of 5 mmHg partial pressure of oxygen (pO2), especially at the periphery of the tumor. We conclude that manipulation of pH or oxygenation has potential to increase the anti-tumor effects of minimally invasive cryosurgical techniques. Furthermore, the dynamic changes in oxygenation after freeze injury in vivo suggests value in combining cryotherapy with treatments dependent on oxygenation levels. Ultimately, these may be routes to more reliable treatment response with fewer recurrences.
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Affiliation(s)
- Robert J Griffin
- University of Minnesota, Department of Therapeutic Radiology, 420 Delaware St. SE, MMC 494, Minneapolis, MN 55455, USA.
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Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes. Radiother Oncol 2012; 105:198-202. [DOI: 10.1016/j.radonc.2012.09.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 11/17/2022]
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Philippou P, Yap T, Chinegwundoh F. Third-Generation Salvage Cryotherapy for Radiorecurrent Prostate Cancer: A Centres Experience. Urol Int 2012; 88:137-44. [DOI: 10.1159/000332220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 08/01/2011] [Indexed: 11/19/2022]
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Ng CK, Touma NJ, Chalasani V, Moussa M, Downey DB, Chin JL. The pattern of prostate cancer local recurrence after radiation and salvage cryoablation. Can Urol Assoc J 2011; 5:E125-8. [PMID: 21251474 DOI: 10.5489/cuaj.09116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We assessed the pattern of local recurrence after salvage cryoablation of the prostate, and the impact of local recurrence on intermediate-term outcome. METHODS One hundred twenty-two patients who underwent salvage cryoablation were studied after a mean follow-up of 56 months. Serial prostate biopsy was carried out after cryoablation. The histopathology of prostate biopsies before and after cryoablation were compared. The prognostic value of post-cryoablation biopsy was assessed with the Cox regression method. RESULTS 23.1% of patients had a positive biopsy for prostate cancer following salvage cryoablation. Most cancer recurrences occurred in the apex (51.5%), base (21.2%) and seminal vesicles (18.2%). The presence of cancer at the base of the prostate was found to be a prognostic factor for eventual biochemical failure. Overall 5-year biochemical disease-free survival (bDFS) was 28%, however patients with cancer at the base of the prostate had a 5-year bDFS of 0%. CONCLUSION Cancer recurrences occurred in areas where aggressive freezing was avoided as it might result in serious problems (e.g., urethro-rectal fistula and incontinence). Post-cryoablation biopsies and the location of persistent disease are of prognostic value.
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Affiliation(s)
- Chee Kwan Ng
- From the Division of Urology, Department of Pathology and Department of Radiology, London Health Sciences Centre, University of Western Ontario, London, ON
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Berge V, Baco E, Karlsen SJ. A prospective study of salvage high-intensity focused ultrasound for locally radiorecurrent prostate cancer: Early results. ACTA ACUST UNITED AC 2010; 44:223-7. [DOI: 10.3109/00365591003727551] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Viktor Berge
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway
| | - Eduard Baco
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway
| | - Steinar Johan Karlsen
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
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Pisters LL, Leibovici D, Blute M, Zincke H, Sebo TJ, Slezak JM, Izawa J, Ward JF, Scott SM, Madsen L, Spiess PE, Leibovich BC. Locally recurrent prostate cancer after initial radiation therapy: a comparison of salvage radical prostatectomy versus cryotherapy. J Urol 2009; 182:517-25; discussion 525-7. [PMID: 19524984 DOI: 10.1016/j.juro.2009.04.006] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE We compared the treatment outcomes of salvage radical prostatectomy and salvage cryotherapy for patients with locally recurrent prostate cancer after initial radiation therapy. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients who underwent salvage radical prostatectomy at the Mayo Clinic between 1990 and 1999, and those who underwent salvage cryotherapy at M. D. Anderson Cancer Center between 1992 and 1995. Eligibility criteria were prostate specific antigen less than 10 ng/ml, post-radiation therapy biopsy showing Gleason score 8 or less and prior radiation therapy alone without pre-salvage or post-salvage hormonal therapy. We assessed the rates of biochemical disease-free survival, disease specific survival and overall survival in each group. Biochemical failure was assessed using the 2 definitions of 1) prostate specific antigen greater than 0.4 ng/ml and 2) 2 increases above the nadir prostate specific antigen. RESULTS Mean followup was 7.8 years for the salvage radical prostatectomy group and 5.5 years for the salvage cryotherapy group. Compared to salvage cryotherapy, salvage radical prostatectomy resulted in superior biochemical disease-free survival by both definitions of biochemical failure (prostate specific antigen greater than 0.4 ng/ml, salvage cryotherapy 21% vs salvage radical prostatectomy 61% at 5 years, p <0.001; 2 increases above nadir with salvage cryotherapy 42% vs salvage radical prostatectomy 66% at 5 years, p = 0.002) and in superior overall survival (at 5 years salvage cryotherapy 85% vs salvage radical prostatectomy 95%, p = 0.001). There was no significant difference in disease specific survival (at 5 years salvage cryotherapy 96% vs salvage radical prostatectomy 98%, p = 0.283). After adjusting for post-radiation therapy biopsy Gleason sum and pre-salvage treatment serum prostate specific antigen on multivariate analysis salvage radical prostatectomy remained superior to salvage cryotherapy for the end points of any increase in prostate specific antigen greater than 0.4 ng/ml (HR 0.24, p <0.0001), 2 increases in prostate specific antigen (HR 0.47, p = 0.02) and overall survival (HR 0.21, p = 0.01). CONCLUSIONS Young, healthy patients with recurrent prostate cancer after radiation therapy should consider salvage radical prostatectomy as it offers superior biochemical disease-free survival and may potentially offer the best chance of cure.
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Affiliation(s)
- Louis L Pisters
- Department of Urology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Cryosurgery for Prostate Cancer: an Update on Clinical Results of Modern Cryotechnology. Eur Urol 2009; 55:76-86. [DOI: 10.1016/j.eururo.2008.08.063] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/26/2008] [Indexed: 12/29/2022]
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Eisenberg ML, Shinohara K. Partial Salvage Cryoablation of the Prostate for Recurrent Prostate Cancer After Radiotherapy Failure. Urology 2008; 72:1315-8. [DOI: 10.1016/j.urology.2008.03.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/23/2008] [Accepted: 03/26/2008] [Indexed: 11/28/2022]
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Tharp M, Hardacre M, Bennett R, Jones WT, Stuhldreher D, Vaught J. Prostate high-dose-rate brachytherapy as salvage treatment of local failure after previous external or permanent seed irradiation for prostate cancer. Brachytherapy 2008; 7:231-6. [DOI: 10.1016/j.brachy.2008.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 03/24/2008] [Accepted: 03/26/2008] [Indexed: 10/21/2022]
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Liu JB, Wansaicheong G, Merton DA, Chiou SY, Sun Y, Li K, Forsberg F, Edmonds PR, Needleman L, Halpern EJ. Canine prostate: contrast-enhanced US-guided radiofrequency ablation with urethral and neurovascular cooling--initial experience. Radiology 2008; 247:717-25. [PMID: 18413888 DOI: 10.1148/radiol.2473071334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To prospectively evaluate in a canine model contrast material-enhanced ultrasonography (US) for guiding and monitoring radiofrequency (RF) ablation of the entire prostate, with urethral and vascular cooling to protect the surrounding structures. MATERIALS AND METHODS After approval by the institutional animal use and care committee, an RF electrode was used to ablate the entire prostate in 15 dogs. During ablation, pulse-inversion harmonic US was performed by using an endocavitary probe after an intravenous bolus injection (0.04 mL/kg) and infusion (0.015 muL/kg/min) of a US contrast agent. In group 1 (n = 4), no cooling protection was used during ablation. In group 2 (n = 5), urethral and bladder protection was provided by inserting a 12-F catheter infused with cold saline (8 degrees C +/- 4 [standard deviation]) at a rate of 100 mL/min. In group 3 (n = 6), further protection of the neurovascular bundles (NVBs) was provided by infusing cold saline (8 degrees C +/- 4) into the iliac arteries at a rate of 50 mL/min by means of catheterization of the femoral artery. Pathologic findings among the three groups were compared by using the Wilcoxon rank sum test. RESULTS The average volumes of prostate ablation achieved in the three groups were 96.6%, 91.9%, and 92%. Contrast-enhanced pulse-inversion harmonic US allowed visualization and monitoring of urethral and NVB blood flow during the ablation. Without protection, damage to the urethra and the NVB was demonstrated at both US and pathologic examination. There was highly significant difference in urethral damage between groups with and the group without urethral cooling (P = .002), while intraarterial cooling demonstrated a nonsignificant trend toward a decreased NVB damage (P = .069). CONCLUSION Contrast-enhanced US can guide RF ablation of the entire prostate. Infusion of cold saline provides effective protection for the urethra during such procedures. The application of intraarterial cooling did not provide a significant improvement in the protection of the NVB in this small study.
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Affiliation(s)
- Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, 7th Floor Main Building, 132 S 10th St, Philadelphia, PA 19107, USA.
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Abstract
BACKGROUND Cryosurgery has gained popularity as a minimally invasive treatment option for primary and recurrent prostate cancer. Herein we present a review and summary reports on primary cryoablation for prostate cancer and salvage cryoablation following radiation failure. METHODS We reviewed the current published literature in the English language on these topics, along with some historic articles dating back to the 1960s for background and development of the procedure. The material is supplemented by some commentary based on our own 13-year experience with cryoablation for prostate cancer. The review is divided into two sections: primary and salvage cryoablation. RESULTS For primary cryoablation, success rates are proportional to the risk categories of the primary cancers. A pretreatment prostate-specific antigen (PSA) <or= 10 ng/mL and an undetectable PSA nadir following cryoablation are associated with a more favorable long-term outcome. Safety profile and quality of life are acceptable in carefully selected patients. Similarly, for salvage cryoablation following radiation failure, patient selection is of paramount importance. The most consistently identified predictive factors for poor cryoablation outcomes were pre-cryoablation PSA > 10 ng/mL and post-cryoablation nadir PSA > 1 ng/mL for salvage procedures. Side effects are more prevalent and serious than with primary cryoablation but for carefully selected patients, the long-term results are favorable. CONCLUSIONS Patient selection is the key to success with cryoablation, in both the primary and salvage setting. The modality can offer long-term cancer control in carefully selected patient with properly executed techniques.
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Affiliation(s)
- Joseph L Chin
- Division of Urological Surgery, University of Western Ontario, London, Canada N6A 4G5.
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Dudderidge T, Payne H, Emberton M. An algorithm for managing the failure of external beam radiotherapy in prostate cancer. BJU Int 2007; 100:518-27. [PMID: 17573894 DOI: 10.1111/j.1464-410x.2007.06999.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present a management algorithm for men with prostate cancer recurring after external beam radiotherapy (EBRT), based on a review of published reports, to assist clinicians in identifying men who are suitable for salvage therapy and to help them to decide which type of salvage treatment is most likely to confer the desired outcome with the minimum of harm. METHODS Men with radiorecurrent prostate cancer require special consideration; they tend to be older, have more comorbidity and have worse disease than their contemporaries having primary treatment. Salvage treatment is compromised by the irradiated pelvis, resulting in increased treatment toxicity. Using the Pubmed database and reference lists of key articles, we identified studies relating to the management of radiorecurrent prostate cancer; the findings were incorporated into a management algorithm and summary table of treatments. RESULTS The American Society for Therapeutic Radiology and Oncology criteria, which define biochemical failure has now been superseded by the Phoenix definition (nadir prostate-specific antigen [PSA] plus 2 ng/mL). Biochemical follow-up after EBRT should be 3-monthly until the PSA level has reached a stable nadir after withdrawing androgen suppression. Contrast-enhanced dynamic magnetic resonance imaging (MRI) is an accurate tool and can be used for both the diagnosis and staging of patients with prostate cancer, in conjunction with prostate biopsies. Prostate biopsies should only be considered >2 years after EBRT to avoid false-positive results. In addition to MRI, high-risk cases being considered for salvage therapy should be considered for laparoscopic lymph-node dissection to exclude micrometastases. Deferred androgen suppression, laparoscopic or open radical prostatectomy, cryotherapy and high-intensity focused ultrasound all seem reasonable salvage treatment approaches. CONCLUSION Through improved methods of detection, including frequent PSA measurements, modern imaging and carefully obtained biopsies, those with radiorecurrent disease can be identified before their disease has spread. Rigorous staging will exclude those with micrometastases. The minimally invasive salvage therapies seem to offer an advantage over salvage surgery to patients in whom the benefits and harms are so finely balanced.
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Affiliation(s)
- Tim Dudderidge
- University College London Hospitals NHS Foundation Trust, and Institute of Urology, Division of Surgical and Interventional Sciences, University College London, London, UK.
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19
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Huang WC, Kuroiwa K, Serio AM, Bianco FJ, Fine SW, Shayegan B, Scardino PT, Eastham JA. The anatomical and pathological characteristics of irradiated prostate cancers may influence the oncological efficacy of salvage ablative therapies. J Urol 2007; 177:1324-9; quiz 1591. [PMID: 17382724 DOI: 10.1016/j.juro.2006.11.069] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Recurrent or radioresistant prostate cancer occurs in approximately 30% of men receiving primary radiotherapy. For men who are candidates for local salvage therapy, the oncological efficacy of ablative therapies may be affected by the anatomical and pathological features of cancers within irradiated prostate glands. We characterized and mapped the prostate cancers in our series of whole mount salvage radical prostatectomy specimens. MATERIALS AND METHODS A total of 47 salvage radical prostatectomies were performed at our institution between 2000 and 2004. Detailed pathological data, including the anatomical distribution of cancers, were obtained from 46 whole mount salvage radical prostatectomy specimens. RESULTS A total of 70 cancer foci were identified in 46 specimens. Of the specimens 93% had cancer foci at the apex. The median minimum cancer-to-urethra distance was smallest at the apex (4.1 mm) and greatest at the base (13.8 mm). More than 65% of patients had cancer 5 mm or less from the urethra and 7% of patients had cancer directly involving the urethra. Nearly half of all patients had evidence of extraprostatic disease. CONCLUSIONS The anatomical and pathological features in our study demonstrate that a significant portion of irradiated cancers are pathologically advanced and distributed in regions of the prostate (apical and periurethral) which are at risk for undertreatment using current ablative therapies. Our findings raise serious concerns regarding the oncological efficacy of such treatment modalities. Long-term studies without the use of hormonal therapy are needed to determine the oncological efficacy of salvage ablative therapies in patients with radiorecurrent or resistant prostate cancer.
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Affiliation(s)
- William C Huang
- Departments of Urology, Biostatistics/Epidemiology and Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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20
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Galosi AB, Lugnani F, Muzzonigro G. Salvage Cryosurgery for Recurrent Prostate Carcinoma after Radiotherapy. J Endourol 2007; 21:1-7. [PMID: 17263599 DOI: 10.1089/end.2006.9999] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cryotherapy is a salvage treatment for patients with biopsy-proved prostatic adenocarcinoma recurrent after radiotherapy. Proper sampling, labeling, and analysis of prostate biopsies allows prompt diagnosis, identification of important prognostic parameters, and planning of an appropriate therapeutic strategy. Whereas androgen-suppressive therapy is associated with only a temporary benefit, transperineal salvage cryosurgery offers a potentially curative option for patients with localized disease, even those with significant comorbidities. Technological advances, including computerized treatment planning and miniaturized cryoprobes, may provide further therapeutic advantages and lower complication rates. Cryotherapy should be included among the established therapeutic options for recurrence after radiotherapy.
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Affiliation(s)
- Andrea B Galosi
- Department of Urology, Polytechnic University of Marche Region, AOU Ospedali Riuniti, Ancona, Italy.
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21
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Nguyen PL, D'Amico AV, Lee AK, Suh WW. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure. Cancer 2007; 110:1417-28. [PMID: 17694553 DOI: 10.1002/cncr.22941] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Among men who experience prostate-specific antigen (PSA) failure after external beam radiation or brachytherapy (RT), many will harbor occult micrometastases; however, a significant minority will have a true local-only failure and, thus, potentially may benefit from a salvage local therapy. Those most likely to have a local-only failure initially have low-risk disease (PSA < 10 ng/mL, Gleason score < or =6, clinical T1c or T2a tumor status), pretreatment PSA velocity < 2.0 ng/mL per year at the time of initial presentation, interval to PSA failure > 3 years, PSA doubling time > 12 months, negative bone scan and pelvic imaging, and positive rebiopsy. In addition, men with presalvage PSA levels > 10 ng/mL, presalvage T3/T4 disease, or presalvage Gleason scores > or =7 on a rebiopsy sample without significant RT effects are unlikely to be cured by salvage local therapy. Based on a review of all series of post-RT salvage prostatectomy, cryosurgery, and brachytherapy published in English since 1990, morbidity can be substantial. Although urinary incontinence appeared to be greater after salvage prostatectomy (41%) or cryosurgery (36%) than after brachytherapy (6%), patients who received salvage brachytherapy faced a 17% risk of grade 3 or 4 genitourinary complications and a fistula risk that averaged 3.4% across all series. From this review, the authors concluded that prospective randomized studies are needed to determine the relative efficacy of the 3 major local salvage modalities and that additional research is needed to identify factors associated with an increased risk of significant complications to improve patient selection and to augment the benefit/risk ratio associated with attempts to cure local-only recurrences after radiation therapy.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA.
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22
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Spiess PE, Lee AK, Leibovici D, Wang X, Do KA, Pisters LL. Presalvage prostate-specific antigen (PSA) and PSA doubling time as predictors of biochemical failure of salvage cryotherapy in patients with locally recurrent prostate cancer after radiotherapy. Cancer 2006; 107:275-80. [PMID: 16770783 DOI: 10.1002/cncr.21979] [Citation(s) in RCA: 278] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The value of presalvage cryotherapy serum PSA level in predicting biochemical failure in patients with local recurrence of prostate cancer (PCa) after radiotherapy was documented; however, little is known about the predictive value of prostate-specific antigen (PSA) doubling time (DT) in this patient group. The purpose of the current study was to evaluate serum PSA level and PSA DT as predictors of salvage cryotherapy outcomes in patients being treated for postradiotherapy locally recurrent PCa. METHODS The charts of patients treated with salvage cryotherapy were retrospectively reviewed for locally recurrent PCa at the M. D. Anderson Cancer Center from January 1980 to July 2004. Patients who received neoadjuvant or adjuvant hormone therapy were excluded. We assessed pre- and postradiotherapy clinical data, pre- and postsalvage cryotherapy clinical data, and other variables. Kaplan-Meier and log rank tests were performed to assess unadjusted survival probabilities and 2-group survival comparisons, respectively. Cox proportional hazards regression models were used to assess the effect of patient characteristics in predicting overall, disease-specific, and biochemical failure-free survival. RESULTS Forty-nine patients met the eligibility criteria. The median age of patients at diagnosis was 66 years (58-81 years) with the initial clinical stage before radiotherapy most commonly T2 (n = 25) or T3 (n = 21). The median presalvage cryotherapy serum PSA level was 5.9 ng/mL (0.4-23.1 ng/mL) and the presalvage prostatic biopsies were frequently high grade (Gleason grade > or =8 in 51% of patients). The median postsalvage cryotherapy serum PSA level was 0.1 ng/mL (0.1-9.5 ng/mL), and biochemical failure (defined as a serum PSA level > or =2 ng/mL above the postsalvage cryotherapy PSA nadir) occurred in 26 patients. In these 26 patients, there was a statistically significant difference between pre- and postsalvage cryotherapy PSA DTs (12.3 months to 5.6 months, respectively; P = .02). A presalvage cryotherapy serum PSA level >10 ng/mL (P = .002) and PSA DT < or =16 months (P = .06) were found to predict the subsequent risk of biochemical failure. CONCLUSIONS Presalvage PSA and PSA DT can predict biochemical failure of salvage cryotherapy, although the predictive value of PSA DT only trended toward significance. The statistically significant difference in pre- and postsalvage cryotherapy PSA DTs was reflective of aggressive tumor biology.
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Affiliation(s)
- Philippe E Spiess
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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23
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Shariat SF, Raptidis G, Masatoschi M, Bergamaschi F, Slawin KM. Pilot study of radiofrequency interstitial tumor ablation (RITA) for the treatment of radio-recurrent prostate cancer. Prostate 2005; 65:260-7. [PMID: 16015591 DOI: 10.1002/pros.20242] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND To prospectively evaluate the feasibility, safety, morbidity, and preliminary efficacy of radiofrequency interstitial tumor ablation (RITA) for the focal treatment of patients with local prostate cancer recurrence. METHODS Eleven patients with biopsy-proven, hormone-naïve, clinically localized prostate cancer were enrolled in a prospective phase I/II trial. Eight patients had failed prior radiation therapy and three were not candidates for curative primary therapy (median Gleason score 7 and 6, respectively). Median follow-up was 20 months. All patients were treated with RITA in an office setting, under intravenous sedation and were discharged after the procedure. Radiofrequency energy was applied via needles placed transperineally under transrectal ultrasound guidance. RESULTS The placement of 1/4 lesions was aborted in two patients due to increasing rectal temperature. Complications included transient macrohematuria (19%), bladder spasms (9%), and dysuria (9%). Serum PSA levels decreased after RITA >50% in 90% of patients, > 70% in 72% of patients, and > 80% in 46% of patients. The mean PSA doubling time after RITA was slower than that before RITA (37 +/- 22 months vs. 14 +/- 13 months, P = 0.008). At 12 months after RITA, 50% of patients with sufficient follow-up had no residual cancer on repeat systematic 12-core biopsy cores and 67% were cancer-free in biopsy cores sampled from the RITA-treated areas. CONCLUSIONS RITA treatment is a minimal invasive, rapid, user-friendly, office-based procedure that is well tolerated. Focal ablation with RITA results in effective local disease control in patients with non-metastatic prostate cancer recurrence. Larger, prospective, multicenter clinical studies are needed to confirm these findings.
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Affiliation(s)
- Shahrokh F Shariat
- Baylor Prostate Center, Scott Department of Urology, Baylor College of Medicine, and The Methodist Hospital, Houston, Texas 77030, USA
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Kadoch C, D'Amico AV, Matthews RH. When Prostate Brachytherapy Fails: A Case Report and Discussion. Oncologist 2005; 10:799-805. [PMID: 16314290 DOI: 10.1634/theoncologist.10-10-799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For appropriately selected brachytherapy patients, prostate-specific antigen failure is uncommon. Our patient experienced biochemical failure after 125I brachytherapy treatment for low-risk prostate adenocarcinoma. We suggest neoadjuvant/adjuvant hormonal therapy combined with pelvic external-beam radiation therapy as a reasonable salvage treatment. At the 2-year follow-up, he is apparently doing well. With limited data available, salvage management for this situation is presently investigational.
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Janzen NK, Han KR, Perry KT, Said JW, Schulam PG, Belldegrun AS. Feasibility of nerve-sparing prostate cryosurgery: applications and limitations in a canine model. J Endourol 2005; 19:520-5. [PMID: 15910269 DOI: 10.1089/end.2005.19.520] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE In a canine model, we evaluated the feasibility of nerve-sparing cryosurgery by active warming of the neurovascular bundle (NVB). Furthermore, our aim was to determine if NVB warming increases the risk of acinar gland and stromal-tissue preservation in adjacent areas of the prostate. The effects of a single versus double freeze-thaw cycle on prostate tissue were also assessed. MATERIALS AND METHODS Ten prostate lobes from five dogs were evaluated. Nine lobes from five dogs were treated with cryoablation using 17-gauge gas-driven cryoneedles. Seven lobes wre treated with active warming of the NVB using helium gas, and two lobes were treated without active warming. A single or double freeze-thaw cycle was utilized. Prostate tissue ablation and NVB preservation were evaluated in histologic sections. RESULTS All seven prostate lobes treated with active warming demonstrated complete or partial NVB preservation. Four of these lobes had adjacent gland preservation. All lobes treated with a double freeze-thaw cycle showed complete and uniform ablation of prostate tissue. One of the three lobes treated with a single freeze-thaw cycle demonstrated incomplete ablation of the tissue. CONCLUSIONS This is the first study investigating the feasibility of NVB preservation under controlled experimental conditions. In our canine model, NVB preservation with active warming was possible but not consistently reproducible. In some cases, NVB preservation with active warming may result in incomplete peripheral tissue ablation. A double, but not a single, freeze-thaw cycle induces complete and effective necrosis of prostatic tissue. These results have significant clinical applications when attempting nerve-sparing cryosurgical ablation of the prostate.
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Affiliation(s)
- Nicolette K Janzen
- Department of Urology, University of California Los Angeles School of Medicine, 90095, USA
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Merrick GS, Wallner KE, Butler WM. Prostate cryotherapy: More questions than answers. Urology 2005; 66:9-15. [PMID: 15992870 DOI: 10.1016/j.urology.2004.12.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 11/22/2004] [Accepted: 12/15/2004] [Indexed: 11/28/2022]
Affiliation(s)
- Gregory S Merrick
- Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia 26003-6300, USA.
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Galosi A, Corsini C, Fabiani A, Pentimone S, Muzzonigro G. Transperineal Salvage Cryosurgery (SC) for Prostate Adenocarcinoma. Urologia 2005. [DOI: 10.1177/039156030507200306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Criteria used for the diagnosis and treatment of recurrent prostate adenocarcinoma after radiotherapy are examined according to recently published studies in the literature. The diagnosis of recurrence is confirmed by the histological test of a biopsy performed due to the gradual increase in prostate-specific antigen (PSA). Proper sampling, nomenclature and analysis of prostate biopsies allow an early diagnosis to identify some important prognostic parameters and to plan the most appropriate therapeutic strategy for every single case. Androgen suppressive therapy only induces a temporary benefit in these patients. Transperineal salvage cryosurgery (SC) represents a recognized effective treatment option. Technological advances, including computerized treatment planning and miniaturized cryoprobes, allow further potential therapeutic advantages and reduce complications. Results of SC are promising even in patients with other comorbidities; therefore, it is useful to include it among therapeutic instruments for failures following radiotherapy.
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Affiliation(s)
- A.B. Galosi
- Clinica Urologica, Istituto di Scienze Materno-Infantili, Dottorato di Ricerca Oncologia Urologica, Università Politecnica delle Marche, Az. Ospedali Riuniti, Ancona
| | - C. Corsini
- Clinica Urologica, Istituto di Scienze Materno-Infantili, Dottorato di Ricerca Oncologia Urologica, Università Politecnica delle Marche, Az. Ospedali Riuniti, Ancona
| | - A. Fabiani
- Clinica Urologica, Istituto di Scienze Materno-Infantili, Dottorato di Ricerca Oncologia Urologica, Università Politecnica delle Marche, Az. Ospedali Riuniti, Ancona
| | - S. Pentimone
- Clinica Urologica, Istituto di Scienze Materno-Infantili, Dottorato di Ricerca Oncologia Urologica, Università Politecnica delle Marche, Az. Ospedali Riuniti, Ancona
| | - G. Muzzonigro
- Clinica Urologica, Istituto di Scienze Materno-Infantili, Dottorato di Ricerca Oncologia Urologica, Università Politecnica delle Marche, Az. Ospedali Riuniti, Ancona
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Touma NJ, Izawa JI, Chin JL. CURRENT STATUS OF LOCAL SALVAGE THERAPIES FOLLOWING RADIATION FAILURE FOR PROSTATE CANCER. J Urol 2005; 173:373-9. [PMID: 15643174 DOI: 10.1097/01.ju.0000150627.68410.4d] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We reviewed the curative options available to patients with local failure after radical radiotherapy for prostate cancer and identified the patients best suited for such salvage therapies. MATERIALS AND METHODS A literature search of English language publications was done using the key terms salvage, prostatectomy, cryosurgery, brachytherapy and radiation failure. RESULTS Salvage radical prostatectomy offers 5-year biochemical relapse-free rates between 55 and 69%. Higher complication rates are reported with salvage compared to primary radical prostatectomy, including rectal injuries, bladder neck contracture and urinary incontinence. Cryosurgery biochemical response rates vary according to the definition of failure but they are generally lower than those of salvage radical prostatectomy. The local control rates of cryosurgery are acceptable. Major complications related to cryotherapy are urinary incontinence, impotence, pelvic pain and urinary retention. Experience with salvage brachytherapy has been limited but some success has been reported in terms of biochemical control. CONCLUSIONS Salvage prostatectomy for localized radiation failure is a good option in the patient with a life expectancy of at least 10 years, preradiation and preoperative prostate specific antigen less than 10 ng/ml, and localized preoperative stage with the understanding that complication risks are higher. Salvage cryotherapy is a valid option in patients with preoperative prostate specific antigen less than 10 ng/ml and Gleason score less than 8, clinical stage less than T3 who are hormonally naive. Salvage cryotherapy is especially suited for older patients with some comorbidities who are still considered to be at reasonable anesthetic risk. The study of brachytherapy remains in its infancy and the efficacy of this modality remains to be determined.
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Affiliation(s)
- Naji J Touma
- Division of Urology, University of Western Ontario, London, Ontario, Canada
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Wilson SS, Crawford ED. Genitourinary malignancies. CANCER CHEMOTHERAPY AND BIOLOGICAL RESPONSE MODIFIERS 2005; 22:485-513. [PMID: 16110626 DOI: 10.1016/s0921-4410(04)22022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Shandra S Wilson
- Department of Urologic Oncology, Anschuz Cancer, Aurora, CO 80010, USA.
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Sauter ER. Commentary. J Surg Oncol 2003. [DOI: 10.1002/jso.10293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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