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Press Release Date: June 22, 1999
A new technology assessment by the U.S. Agency for Health Care Policy and Research (AHCPR) says research is needed to determine the long-term outcomes of cryosurgery in men who undergo the procedure because radiation therapy was not effective in treating their prostate cancer. Cryosurgery destroys diseased tissue by freezing it. An estimated 179,300 men will be diagnosed with prostate cancer in 1999, and 37,000 will die from the disease.
"Some deaths from prostate cancer in patients not helped by radiation therapy may be prevented or delayed by
cryosurgery," said AHCPR's administrator, John M. Eisenberg, M.D., "however, morbidity remains high and we just don't know enough about the long-term effects of the procedure." Dr. Eisenberg said prospective clinical trials appear warranted because they would help determine the long-term survival benefits and make possible comparison of cryosurgery patient survival rates with those of untreated biopsy-positive patients.
AHCPR's technology assessment, which was conducted at the request of the U.S. Health Care Financing Administration—the Federal agency responsible for the Medicare program—found that in the short term, cryosurgery can result in negative prostate biopsies following surgery, and low or undetectable serum PSA levels in some patients. Some patients who have failed radiation therapy have benefited from the use of cryosurgery as a second-line or salvage therapy.
According to the assessment, outcomes of salvage cryosurgery have tended to improve with better instrumentation, better surgical technique, and greater experience on the part of the urologists performing the procedure.
But the assessment also found that while the procedure itself is well tolerated, postoperative complications are significant. Major complications of salvage cryosurgery include incontinence, impotence and obstructive urinary symptoms.
Cryosurgery is increasingly being used as a second-line therapy in men not helped by radiation treatments. Because cryosurgery is better tolerated than traditional prostate cancer surgery—prostatectomy—it can be offered to men who would not normally be candidates for the surgery because of advanced age or the presence of other health problems.
For more information, request a free copy of Cryosurgery for Recurrent Prostate Cancer Following Radiation Therapy. Health Technology Assessment No. 13, AHCPR Publication No. 99-0004, from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907, U.S.A., or phone 1-800-358-9295 from within the United States, or (703) 437-2078 from outside the country.
Note to Editors: AHCPR recently published another assessment of prostate cancer treatment, Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostatic Cancer, Evidence Report/Technology Assessment No. 4, AHCPR Publication No. 99-E011. This report is available without charge from the AHCPR Publications Clearinghouse, or select to access the summary online.
For additional information, contact the AHCPR Press Office (301) 427-1364: Karen Migdail (301) 427-1855 (KMigdail@ahrq.gov).