PROSTATE
CANCER CRYOTHERAPY
Patient Criteria
Prostate Cancer Patient
Profile for Minimally Invasive Cryotherapy Treatment
Age, ethnicity, and family history play a significant role in determining those who are at risk for prostate cancer. Men between 50 and 80 years of age are more susceptible and, therefore, should receive an annual examination. Men over 40 with a family history of prostate cancer – whether by father, brother, or any two close relatives – and African American men over 40 should also have an annual exam. Early screening is highly recommended for men who have or have had multiple male family members diagnosed with prostate cancer. Prostate cancer is very common in men over 80, but is usually slow growing and not life threatening.
Cryotherapy, also known as Cryosurgery,
Cryo, and Cryoablation,
can be effective as primary, salvage, and nerve
sparing minimally invasive treatments for prostate
cancer. To determine eligibility, patients must
meet certain criterion that are not fixed, but
rather vary based on the physician performing
the treatment. Generally, those patients who are
eligible, but not good candidates for radical
prostatectomy, due to ulcerative colitis, Crohn’s
disease, obesity, and cardiac disease, are also
eligible for cryosurgical ablation of the prostate.
Perhaps the best candidates for Cryo are men with
nonmetastatic cancer, with a PSA below ten (10).
Read on to find out the patient profiles for cryotherapy
as a primary or salvage prostate cancer treatment.
Patient Profile for Primary Prostate Cryosurgery
Patients who fit the profile for cryotherapy
ablation as first line monotherapy should
have a Gleason score of six (6) or lower, and
a PSA level of ten (10) or lower, which would
indicate that the prostate cancer is localized.
It is important to determine whether the cancer
is localized because cryotherapy only freezes
the tissue in the prostate gland. The efficacy
of the minimally invasive procedure will not be
will not be as high if the prostate cancer has
spread to the seminal vesicles. The gland itself
should be less than 50 cc. Candidates who have
undergone a transurethral resection of the prostate,
or TURP, may not be eligible for cryoablation
as primary treatment as this procedure leaves
insufficient tissue for growing the iceballs necessary
for ablation.
Patient Profile for Salvage
Cryoablation Treatment
Prostate
cryoablation is a preferred therapy for patients
with localized, radio-resistant prostate cancer.
If radiation therapy fails, prostate cancer patients
are left with limited prostate cancer treatment
options including: radical prostatectomy, which
can be performed with curative intent, but it
risks significant side effects; and hormonal therapy,
which may reduce tumor size and slow growth, but
is ultimately not curative and has a significant
impact on the quality of life. Compared to salvage
radical prostatectomy, salvage cryotherapy exhibits
similar Biochemical Disease-Free Survival (BDFS)
and morbidity rates. The differences between the
two are the side effects with salvage cryo showing
notable reductions in rectal injury and incontinence.
Cryosurgery may not be suitable for those who
have undergone permanent seed implantation through
brachytherapy due to the inert titanium casings,
but for others the minimally invasive treatment
is promising. Perhaps even more promising is the
future of cryotherapy results for prostate cancer.
As the technique develops, many side effects are
reduced, such as impotence which has been known
to occur in virtually 100% of patients treated
with cryosurgery. Before too long, it may be possible
for those in the field of Urology to see “nerve
sparing” cryotherapy become a reality.
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