22 augustus 2009: Een gerandomiseerde studie laat zien dat cryosurgery nog steeds een manier van behandelen is bij niet uitgezaaide prostaatkanker die weinig tot geen bijwerkingen geeft en uitstekende resultaten op de overlevingskansen van de prostaatkanker. Echter in een recente gerandomiseerde studie blijkt dat patienten met prostaatkanker die cryosurgery hebben laten doen later (3 jaar en meer) wat meer problemen hebben op het gebied van sexualiteit dan mannen die gericht bestraald zijn van buitenaf (13% meer in de cryosurgerygroep gaf aan wel problemen te hebben met de verminderde potentie) . Ik moet er wel bij opmerken dat deze resultaten voortkomen uit een vragenlijst en het resultaat dus nogal afhankelijk is van de persoon zelf hoe die dingen ervaart. Wie bewust kiest voor cryosurgery zou misschien ook kritischer kunnen zijn op bijwerkingen dan iemand die netjes de standaard aanpak volgt. Ik weet het niet maar vroeg me dat zo af. Verder gaven beide behandelmethoden goede resultaten en weinig tot geen blijvende bijwerkingen. Zie onder dit recente abstract ook informatie over studies met cryosurgery al uit 2002.

1: Cancer. 2009 Aug 18. [Epub ahead of print]Click here to read Links

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer: quality of life outcomes.
Robinson JW, Donnelly BJ, Siever JE, Saliken JC, Ernst SD, Rewcastle JC, Trpkov K, Lau H, Scott C, Thomas B.
Departments of Oncology and Clinical Psychology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta.
BACKGROUND:: A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease-specific survival. We report on the quality of life (QOL) outcomes for this trial.
METHODS:: From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant antiandrogen therapy. Patients completed the EORTC QLQ C30 and the Prostate Cancer Index (PCI) before treatment and at 1.5, 3, 6, 12, 18, 24, and 36 months post-treatment.
RESULTS:: Regardless of treatment arm, participants reported high levels of QOL with few exceptions. cryoablation was associated with more acute urinary dysfunction (mean PCI urinary function cryoablation = 69.4; mean EBRT = 90.7; P < .001), which resolved over time. No late arising QOL issues were observed. Both EBRT and cryoablation participants reported decreases in sexual function at 3 months with the cryoablation patients reporting poorer functioning (mean cryoablation = 7.2: mean EBRT = 32.9; P < .001). Mean sexual function score was 15 points lower at 3 years for the cryoablation group and 13% more of the cryoablation men said that sexuality was a moderate or big problem.
CONCLUSIONS:: In this randomized trial, no long-term QOL advantage for either treatment was apparent with the exception of poorer sexual function reported by those treated with cryoablation. Men who wish to increase their odds of retaining sexual function might be counseled to choose EBRT over cryoablation. Cancer 2009. (c) 2009 American Cancer Society.
PMID: 19691092 [PubMed - as supplied by publisher]
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d.d. 30 mei 2002: Een zeven jaar durende studie bevestigt wat al langer bekend was bij urologen en deskundigen op het gebied van prostaatkanker dat cryosurgery bij prostaatkanker veruit te prefereren is boven brachytherapie en andere reguliere behandelingen van prostaatkanker. (zie ook ander bericht onder dit bericht van een andere studie gedaan door dr. Onik d.d. november 2001) In de nieuwste studie wordt respectievelijk 92%, 89% en 89% succes (=ziektevrij) gemeten bij laag, middel en hoog risico patiënten met prostaatkanker. Met veelal een behoud of terugkeer van sexuele functies. Deze studie wordt komende maand gepubliceerd in het toonaangevende medische tijdschrift Urology. Zie hieronder volledige persbericht van de producent Endocare.. Zie voor informatie over vergelijkbare operatietechniek Radio Frequency Ablation met vele zeer positieve studieresultaten op pagina kankersoorten-RFA. Bij RFA wordt met hitte gewerkt, bij crysurgery met bevriezen.

Endocare Reports New Data Shows Cryosurgery Produces 92 Percent Disease Free
Rates as Primary Treatment for Prostate Cancer

7-Year Data to be Published in Journal Urology Shows Cryoablation Superior to
Brachytherapy; Study Shows Significant Improvement in Post-Procedure Potency
Over Time With No Radiation Risk

IRVINE, Calif., May 29 /PRNewswire-FirstCall/ -- Endocare Inc. (Nasdaq:
ENDO), a developer of innovative diagnostic and treatment tools for cancer and
other diseases, announced today that seven-year follow-up data from a
peer-reviewed, retrospective study demonstrated that cryoablation as a
first-line treatment for prostate cancer can be equally or more effective than
brachytherapy, without the potentially toxic side affects of radioactive seeds.
The 590-patient study, to be published in the upcoming edition of the journal
Urology and presented by clinical researchers at a Company-sponsored forum held
in conjunction with the American Urological Association (AUA) annual meeting in
Orlando, showed disease-free survival rates for low, medium and high risk
patients were 92 percent, 89 percent and 89 percent respectively, as measured
using the American Society for Therapeutic Radiology and Oncology (ASTRO)
definition. These results compare favorably with existing survival data
associated with other treatment modalities such as brachytherapy, especially in
medium- to high-risk patients.
In an additional study to be published in the same Urology article,
three-year prospective data measuring patients' quality of life before targeted
cryoablation as well as at regular intervals after the procedure showed for the
first time that sexual function often returns after cryoablation. The data
demonstrated that 47 percent of men who were sexually active before the
procedure ultimately resumed having intercourse within the three year period --
a trend comparable to the reported 50 percent of men that undergo brachytherapy
whose sexual function returns over time.
Daniel B. Rukstalis, M.D., Head of the Division of Urology, MCP Hahnemann
University School of Medicine and Guest Editor of the special Urology issue,
said that improving cryosurgical techniques are leading to improved outcomes
-- both in terms of successfully treating the disease and in controlling
morbidity -- and are compelling the urology community to rethink its primary
treatment option for prostate cancer.
"What may have been considered a novel medical technology a decade ago has
today come into its own as a powerful tool against cancer," Rukstalis said.
"This new long-term survival data on targeted cryoablation, combined with its
minimally invasive nature and its low morbidity rates, indicate its growing
importance as a primary therapy. In addition, it is a procedure that can be
easily repeated in those few instances where the cancer may reoccur, unlike
Paul Mikus, President and CEO of Endocare, said the new clinical data
continues to validate cryosurgery as a viable, and many times preferable,
option for the treatment of prostate.
"This seven-year data validates the claims of the pioneering physicians
who adopted this technology during the past decade," Mikus said. "Today, men
have a minimally invasive option that has been shown clinically superior in
treating their disease -- involving no radiation and fewer side affects. I
expect the number of men seeking out this approach will grow, as will the
number of physicians who have considered the data and wish to offer their
patients a choice."

About Targeted Cryoablation
While radical prostatectomy has historically been the "gold standard" for
treatment of prostate cancer, many men are considering less-invasive treatment
options that involve faster recovery, less severe side effects and fewer
complications. Targeted cryosurgery is a minimally invasive procedure that
involves no radiation or open surgery and only one percent of patients report
During targeted cryosurgery, a patient is first treated with epidural
anesthesia; he is awake and can talk to the physician, but feels no pain during
the procedure. The physician inserts slender cryoprobes through a small
incision into the prostate gland. Liquefied argon gas, which is contained
within the cryoprobe tips, freezes the cancerous tissue reaching -- 40 degrees
Celsius (- 40 degrees Fahrenheit). After approximately 10 minutes, the
physician completes the first freeze cycle and then immediately administers
another treatment to help ensure that all cancer cells are killed.
The entire procedure lasts about one to two hours and the patient can return
home that day or the next morning. In general, patients can resume a normal
lifestyle immediately after the procedure. Some patients may experience mild
soreness for two to three days following targeted cryosurgery; however, this
side effect is common among all surgical prostate cancer treatments. Long-term
side effects of targeted cryosurgery are similar to other therapies and may
include impotence, bladder outlet obstruction, pelvic pain, chronic urgency and
rectal injury.

Onderstaand bericht is een bevestiging van bovenstaand nieuws dat we al eerder melden.



CHICAGO (Reuters Health) Nov 28 - Focused cryosurgery for ablation of a single prostate lesion is a safe alternative to nerve-sparing prostatectomy, with little to no effect on sexual potency, according to study findings presented at the 87th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

Dr. Gary M. Onik, director of surgical imaging at the Center for Surgical Advancement, Florida Hospital Celebration Health, Celebration, Florida, explained that because cryosurgery "causes no trauma at all to the nerve," the procedure can preserve potency "even when we remove one nerve, because the remaining nerve is untouched, fine."

He said that nerves and other anatomy, including the rectum, are spared because "we manipulate the lesion by injecting saline into the surrounding tissue before freezing. This effectively creates wider margins."

Dr. Onik reported results from a series of nine patients. The men were all high-risk patients with a prostate-specific antigen of more than 10, a Gleason score of at least 7 and/or T2 lesions. The age range was 55 to 70.

"Seven of the nine men have retained full potency," Dr. Onik reported. Moreover, the procedure was done on an outpatient basis and the men were able to return to work in 5 days. "That compares with weeks of recovery after surgery, including possibly 6 weeks of daily radiation," Dr. Onik said.

"All of the patients have stable PSA, and six of the men have had negative biopsies," Dr. Onik said. There was no incontinence associated with the procedure.

While two men did not retain potency, cryosurgery was "a successful cancer treatment for them," he said. In one man, the first patient in the series, "both nerves were frozen. We didn't intend to do that, but we were still learning," said Dr. Onik. The other man had a number of comorbidities, including a previous prostate surgery that contributed to impotence.

Dr. Onik told Reuters Health that the procedure is much less costly than surgery, and "cryosurgery is already FDA-approved, so this option is available right now." Although high-risk patients were enrolled in the series, Dr. Onik said the greatest potential for focused cryosurgery is "for men who are in that middle group, the watchful waiting patients. Why not offer them a treatment rather than waiting for the cancer to progress?"

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