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Outcomes/Effectiveness Research

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More long-term research is needed on cryosurgery as a second-line therapy for prostate cancer

A new technology assessment by the Agency for Health Care Policy and Research 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.

Although some deaths from prostate cancer in patients not helped by radiation therapy may be prevented or delayed by cryosurgery, morbidity remains high. We just don't know enough about the long-term effects of the procedure, according to AHCPR Administrator John M. Eisenberg, M.D. Prospective clinical trials appear to be warranted because they would help determine the long-term survival benefits and make possible a 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 Health Care Financing Administration (HCFA)—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.

Free copies of the assessment, Cryosurgery for Recurrent Prostate Cancer Following Radiation Therapy, Health Technology Assessment No. 13 (AHCPR Publication No. 99-0004), are available from the AHCPR Clearinghouse.

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