TITLE:
Combined cryotherapy and external beam radiation therapy for the treatment of intermediate-risk localized prostate cancer: A case series
AUTHORS:
Peter Qi, Matvey Tsivian, Zeljko Vujaskovic, Thomas J. Polascik
KEYWORDS:
External Beam Radiation; Cryotherapy; Localized Prostate Cancer; Intermediate Risk
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.1,
January
21,
2014
ABSTRACT:
Introduction: Routine PSA screening for prostate cancer
(PCa) has increased the detection of intermediate-risk, localized disease. Conventional
treatments for localized PCa include surgery, brachytherapy, cryotherapy or
external beam radiotherapy (EBRT). However, for intermediate risk patients,
rates of recurrence are moderately high and a multi-modal treatment approach
for these patients may be necessary. We treated patients with a combination of
cryotherapy and low dose EBRT to assess the safety and feasibility of this
combinatory approach as well as to evaluate early oncological outcomes. Case Presentation: Men with intermediate
risk (PSA = 10-20 ng/ml and/or Gleason = 7 and/or clinical T2b) localized PCa
were prospectively enrolled in this study. Patients underwent cryotherapy and
then 39 Gy EBRT 4-6 weeks after surgery. After completing EBRT, the men were
followed every 3 months for 2 years. Adverse events, PSA, urinary and erectile
function were assessed during each follow-up. Three patients completed the
study. Preoperative PSA ranged from 3.5 to 7.9 ng/ml. There were no intraoperative
complications and the treatment was well tolerated. Following cryotherapy and
EBRT, all patients were pad-free within 6 months and remained continent for the
duration of the study. Bother index remained stable throughout the study for
all patients. No urethral strictures or rectal toxicities were observed. PSA
remained undetectable for all patients. Conclusions:
In this prospective study, cryotherapy combined with low dose EBRT was a safe
approach for the treatment of intermediate-risk, localized PCa. Early
oncological outcomes appeared to be favorable with all patients having
undetectable PSA during the 2-year follow-up period. Further studies are
warranted to confirm these preliminary results.