Outcomes of Cryotherapy for Prostate Cancer
in [Prostate Cancer]
|
Prev: Pomegranate extract inhibits tumor angiogenesis & VEGF in human prostate cancer cells in vitro and in vivo
Next: Regulation of prostate cancer cell growth and PSA expression by angiotensin II receptor blocker
From: Matti Narkia on 19 Apr 2007 12:15 Outcomes of Cryotherapy for Prostate Cancer Written by Christopher P. Evans, MD Thursday, 19 April 2007 BERKELEY, CA (UroToday.com) - 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 doi:10.1016/j.urology.2006.10.024 UroToday.com Prostate Cancer Section Excerpted from Outcomes of Cryotherapy for Prostate Cancer <http://www.urotoday.com/61/browse_categories/prostate_cancer/outcomes_of_cryotherapy_for_prostate_cancer.html> -- Matti Narkia
From: ron on 19 Apr 2007 16:33 Hi Matti...Why did you post this article? What point that they were making did you find of value? Most men will select a PCa treatment based on its ability to eradicate the cancer. This excerpt did not describe cancer charcateristics of the men studied, nor did it say what the definition of failure was. The mean (that didn't even use the accepted "median") follow-up was exceedingly short (studies addressing disease feedom need at least 60 months) lessening the accuracy of their projected 40 month bNED. Hence their analysis of the curative efficacy of cryo is extremely lacking. So again, what was it you wanted us to be aware of? That most men suffer ED after cryo? That's certainly not news. Cryo can be a useful treatment for elderly men or men with other co- morbidities. It can also be used to treat recurrences. None of those uses were at the center of this study. Just what was the point?..Best wishes and good health, ron
From: Matti Narkia on 19 Apr 2007 16:59
On 19 Apr 2007 13:33:31 -0700, ron <oitbso(a)yahoo.com> wrote: >Hi Matti...Why did you post this article? One reason was to get feedback, thank you for that ;-). I don't have PCa (to my knowledge, knocking on the wood), so I'm not as familiar with its treatments as I'd like to be. Sometimes posting a study will prompt educated replies like yours, which may benefit me and others. >What point that they were >making did you find of value? Most men will select a PCa treatment >based on its ability to eradicate the cancer. This excerpt did not >describe cancer charcateristics of the men studied, nor did it say >what the definition of failure was. The mean (that didn't even use >the accepted "median") follow-up was exceedingly short (studies >addressing disease feedom need at least 60 months) lessening the >accuracy of their projected 40 month bNED. Hence their analysis of >the curative efficacy of cryo is extremely lacking. So again, what >was it you wanted us to be aware of? That most men suffer ED after >cryo? That's certainly not news. > I recently posted this news article Cryotherapy Endorsed By The European Association Of Urology For Treatment Of Prostate Cancer April 4, 2007 <http://www.cancercompass.com/cancer-news/1,12433,00.htm?rss=y> partly, because here in Finland cryotherapy has been done mainly in one hospital only, which is not in capital Helsinki, and I've seen some remarks about its adverse effects in the Finnish PCa treatment guidelines although in unsatisfactory detail. However, I didn't get any feedback from that message. I'm sure that there are a lot of good studies out there describing pros and cons in great detail, but I have not yet been in the situation where I would have had reason and time to search for them. So perhaps at least part of what I wished was to get some kind of assessment about the cryotherapy vs. other therapies. And you have provided some of that, thanks for it :-). >Cryo can be a useful treatment for elderly men or men with other co- >morbidities. It can also be used to treat recurrences. None of those >uses were at the center of this study. Just what was the point?..Best >wishes and good health, ron > That's something that I wished for, an assessment of applicability. Thanks. Best wishes and good health to you, too. -- Matti Narkia |