From: Proceedings 10th World Congress of Cryosurgery
Cryosurgical ablation of the prostate post radiation failure: the Columbia experience

November 1998
ER Emanuel, MJ Stifelman, JM McKiernan, MC Benson, CA Olsson, AE Katz
Department of Urology, Columbia Presbyterian Medical Center, New York City, NewYork 10032

Introduction and Objectives: Salvage cryosurgical ablation of the prostate (CSAP) hasbeen shown to eradicate radiation recurrent prostate tumors. We present our three-year results in order to evaluate safety, efficacy and quality of life associated with this procedure.

Methods: Between July 1994 and January 1998, 38 patients underwent CSAP after radiation failure. All patients had biopsy-proven local recurrence and all had negative metastatic evaluations. Pre-cryosurgical patient evaluation included initial PSA at time of CAP diagnosis, PSA nadir post radiation, and PSA level and Gleason score at time of radiation failure. Post CSAP evaluation included nadir PSA, prostate cancer recurrence (positive biopsy) and quality of fife.

Results: 38 men age 47-81 (mean 69) have been treated with CSAP at our institution for radiation failure. Pre-radiation PSA level was 5.9-68.5 ng/ml (mean 18.8), nadir PSA was 0-9 ng/n-d (mean 3.3). PSA range at radiation failure was 1-22 ng/ml (mean 7.8). All patients underwent CSAP and follow-up PSA levels. Post CSAP PSA levels ranged from 0-27 ng/ml (mean 1.4). Six of 38 (16%) patients have biopsy-proven recurrence post CSAP. Those patients had PSA range 0.5-27.6 ng/ml (mean 9.2) prior to initiation of hormone therapy. The remaining 32 of 38 patients (84%) have no evidence of recurrence at 1-39 months with range of PSA 0-14.5 ng/ml (mean 1.8). Salvage CSAP complications included incontinence 10%, urethral sloughing 3%, and rectal pain 8.5%. Conclusions: Cryosurgical ablation of the prostate after local radiation failure is a successful salvage procedure. Disease free rates post CSAP are high, complications are minimal and quality of life is preserved.

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