Incomplete glandular ablation after salvage cryotherapy for recurrent prostate cancer after radiotherapy.
OBJECTIVE
To determine the clinical variables associated with inadequate salvage cryotherapy and to correlate the disease-free survival rates associated with biopsy results in prostate cancer (CaP).


METHODS
Between July 1992 and January 1995, 150 patients underwent salvage cryotherapy for locally recurrent CaP. Biopsy specimens were examined for the presence of cancer cells and normal or atypical glands, all of which were considered evidence of inadequate cryotherapy. Clinical variables, as predictors of biopsy results, were evaluated with univariate and multivariate analyses. The impact of the biopsy results on disease-free survival was also determined.


RESULTS
The number of cryoprobes and freeze-thaw cycles correlated with inadequate cryotherapy (p = 0.037 and p = 0.0022, respectively). The number of freeze-thaw cycles was an independent predictor of inadequate cryotherapy (p = 0.003). The finding of cancer cells in the biopsy specimens was the only histopathologic variable that affected disease-free survival (p = 0.016).


CONCLUSIONS
Complete ablation of the prostate gland and tumor is difficult to achieve with salvage cryotherapy. To optimize for complete ablation, salvage cryotherapy should include at least two freeze-thaw cycles and a minimum of five cryoprobes. The finding of atypical or normal epithelial tissue in biopsy specimens after salvage cryotherapy is not predictive of biochemical failure.
Department of Urology, The University of Texas M. D. Anderson Center, Houston, TX 77030, USA.
Jonathan I
JI
Izawa
Nora
N
Morganstern
Deva M
DM
Chan
Lawrence B
LB
Levy
Shellie M
SM
Scott
Louis L
LL
Pisters
D000704:Analysis of Variance; D001706:Biopsy; D003452:Cryosurgery; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000601:surgery*; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012044:Regression Analysis; D016879:Salvage Therapy / Q000379:methods*
D017430:Prostate-Specific Antigen