Each year approximately 50,000 men in the U.S. are treated with radiation therapy for curative treatment for prostate cancer. Sixty percent of this group will have what is known as PSA failure. This means the PSA rises above acceptable limits usually thought to be 2 ng/ml. Not all patients in this group will be diagnosed with recurrent cancer, but a significant number will. This number can be as high as 15-30,000 patients. It is clearly troublesome. However, good answers for this problem exist.
As soon as the PSA failure is recognized, a timely workup is indicated. This will include new methods of imaging known as multi parametric MRI. In addition there are new tumor markers, the most important beyond PSA is known as PCA3.
The good news is that if this workup is done early many times it is possible to see the problem that has developed within the prostate. It may be a single area of cancer that has reoccurred. Using the advanced MRI this can be detected then biopsies can be guided to the specific target representing recurrent disease.
Unfortunately today, this type of workup is not common. Many times the patient is put on LHRH inhibitors (androgen deprivation therapy). The reason for this is that many believe that failure following radiation has no good answer; clearly this is not the case! Additionally, the androgen deprivation therapy has side effects; adverse affects on the heart, blood, in the sense of increased cholesterol, and depression of testosterone which results in thinning of the bone otherwise known as osteoporosis.
With current imaging cryoablation can be targeted to the area of recurrence and result in cure.
This may sound familiar. Twenty five years ago when women were diagnosed with breast cancer the answer was radical mastectomy, today that term is rarely heard. What has replaced it is lumpectomy and many women treated in this way live very full and productive lives.
Likewise when cryoablation is used to eliminate the area of recurrent prostate cancer after radiation failure, the PSA rapidly falls to undetectable levels. Studies done in 2010 at Columbia University in New York City have demonstrated in a group of 900 patients that the 10 year cure rate is approximately 90 percent.
The key to achieving this level of cure is early diagnosis, early workup is indicated, and appropriate treatment based on today’s technology is required. Today many doctors immediately administer androgen deprivation therapy, this needs to be replaced by early diagnosis of the recurrence with the contemporary technologies that are available.
We have produced a short video that overviews the current and evolving treatment utilizing Cryo as Salvage Treatment for Failed Radiation Therapy of Prostate Cancer Please take a few minutes to review this very useful information.