LINTHICUM, MD, October 6, 2008– The American Urological Association (AUA) today announced the release of a new Best Practice Statement on Cryosurgery for the Treatment of Localized Prostate Cancer. This is the first time the AUA has released official guidance on this treatment modality. Due to insufficient long-term data on the efficacy of cryosurgery on metastasis-free, prostate-cancer specific or overall survival, this treatment was not included in the previously released AUA Guideline for the Management of Clinically Localized Prostate Cancer. The new statement was published in the November 2008 issue of The Journal of UrologyÒ and is also available online at www.AUAnet.org.
The newly released best practice statement on cryosurgery seeks to provide medical practitioners with a current understanding of the principles and strategies for the cryosurgical treatment of localized prostate cancer based on review of available professional literature, as well as clinical experience and expert opinion. However, unlike a clinical guideline, best practice statements do not employ formal meta-analysis of the literature.
“With the information we have provided, we hope that physicians will be able to give their patients more information on prostate cancer treatment options. The decision to use one treatment type over others must be a decision made by the physician and the patient after exhaustive review of all available options and their possible complications,” said Richard J. Babaian, MD, chair of the expert panel that developed the statement.
Cryosurgery is a minimally invasive treatment involving the process of freezing – and, as a result, destroying -- cancerous tissue. The procedure is performed through the percutaneous placement of therma probes into the prostate and involves a controlled freezing-thawing process and extremely close monitoring of temperature, freeze cycles and thaw rates. It is often performed as an outpatient procedure, though some patients may require an overnight hospital stay. Operative time averages two hours.
Cryosurgery can be used as both a primary and salvage therapy and, according to the panel, is an option when appropriate patients do not want or are not good candidates for radical prostatectomy because of certain comorbidities. The statement primarily addresses the use of cryosurgery as primary and salvage therapy and presents consensus opinions on each.
Cryosurgery as Primary Therapy: According to the panel, cryotherapy as a first treatment may be a viable option for men with clinically localized prostate cancer (of any grade) with no metastasis. High-risk patients may require multi-modal therapy and those with a large gland volume may require additional management to reduce prostate size to make the treatment more effective. Complications include urinary retention, swelling and fistula formation, in addition to risks for incontinence and erectile dysfunction.
Salvage Cryotherapy: Radiation patients with biochemical recurrence—a rising prostate-specific antigen (PSA) level following treatment–with a prostate-specific antigen of less than 10 ng/ml could be considered candidates for salvage cryotherapy. This secondary treatment is feasible in patients without evidence of metastasis whose local recurrence is detected early. The statement cautions physicians that a number of major variables – including PSA doubling time – must be considered prior to using cryotherapy as a salvage therapy and that it should be performed only in patients with a positive prostate biopsy. Because radiation therapy reduces the size of the prostate, gland volume is not as limiting a factor as it is when cryotherapy is used as a primary treatment. However, some complications – including incontinence (less than 10 % of patients) and rectourethral fistula (0% to 3% of patients) – occurred more frequently in patients undergoing salvage cryotherapy.
The Panel that developed the Best Practice Statement was chaired by Richard J. Babaian, MD, and facilitated by Bryan Donnelly, MD. Other physician members included Duke Bahn, MD; John G. Baust, PhD; Martin Dineen, MD; David Ellis, MD; Aaron Katz, MD; Louis Pisters, MD; Daniel Rukstalis, MD; Katsuto Shinohara, MD; and J. Brantley Thrasher, MD.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients, including UrologyHealth.org, an award-winning on-line patient education resource, and the American Urological Association Foundation, Inc.
Lacey Holt, AUA