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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