Salvage Prostatectomy for Cryoablation Failure

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Tom Wilson - 04 Mar 2004 05:52 GMT

It is very important for me to learn of any experiences anyone has had
regarding this topic. Here's the story:

My father, who turned 71 years old last October, was diagnosed with
prostate cancer from positive biopsies on my 39th birthday last
February (2003). His Gleason score was 7 with more 4's than 3's and a
size of 35. The stage I believe is II and his PSA was between 6 & 7.
After talking to a bright young surgeon about radical prostatectomy
and a local physician who could perform cryoablation at our local
hospital (I live in a major metropolitan area so both were good
treatment centers) he chose cryoablation because it was minimally
invasive. After being diagnosed in early February 2003 he had the
cryoablation done in early April 2003. His first post-cryo PSA in
July was 0.1, his second in October was 0.2, his third in Janaury was
0.4 at which point more biopsies were ordered as well as another PSA.
His PSA at the biopsies was 0.52 and of 14 biopsies taken, two showed
malignant growth scored as an 8 on the Gleason scale, again more 4's
than 3's, but still no 5's.

At this point the original cryo physician won't discuss doing a
salvage prostatectomy and only recommends another cryo-procedure. Dad
is getting a second opinion from a very respected medical center in
this area and also a third opinion from MD Anderson March 11. The
initial conversation for the second opinion turned up something he did
not realize. That is that salvage prostatectomy after cryoablation
can be difficult because of the potential of the cryoablated tissue
crystallizing thus making tissue differentiation and cancerous tissue
removal problematic. Before the second opinion can be offered the
second doctor did an MRI (which we are awaiting results from tomorrow)
that he said would help him understand better the tissue makeup in the
area they believe the cancer is growing.

Does anyone have any knowledge or know of a searchable knowledge base
on any and all recorded experiences of salvage prostatectomy for
cryoablation failure? I've tried hard to search it out on the
internet with very few successful results. Any help relating to any
of the above would be greatly appreciated.

His son and researcher in the mold of the movie "Lorenzo's Oil"

Tom
817-795-0958
tomwilson64@comcast.net

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Leonard Evens - 04 Mar 2004 14:41 GMT

> It is very important for me to learn of any experiences anyone has had
> regarding this topic. Here's the story:
[quoted text clipped - 39 lines]
> 817-795-0958
> tomwilson64@comcast.net

I suggest you start by getting the book Guide to Surviving Prostate
Cancer by Patrick Walsh. There is some discussion of cryoablation
there. Otherwise, you can probably rely on what doctors, at an
established medical center with a good record treating prostate cancer,
tell you. I believe MD Anderson is such a center. I wonder if
radiation may be possible. I had a radical prostatectomy at 67, but
had I been 5 years older, I would have chosen it at a primary therapy.
I'm not sure why it wasn't considered originally in your father's case.

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ron - 04 Mar 2004 15:37 GMT

Hi Tom...I've made some comments within the body of your note. BTW,
you might want to repost this at alt.support.cancer.prostate, there is
a lot more "traffic" in that group.

> It is very important for me to learn of any experiences anyone has had
> regarding this topic. Here's the story:
[quoted text clipped - 9 lines]
> invasive. After being diagnosed in early February 2003 he had the
> cryoablation done in early April 2003.

As I understand it, there are two types of cryo. One where the ENTIRE
prostate is frozen and also a TARGETED cryo, where using doppler
imaging, only the cancerous regions are treated with cryo. Which type
of treatment did your dad have? I suspect he had his entire gland
treated, but I wanted to check.

> His first post-cryo PSA in
> July was 0.1, his second in October was 0.2, his third in Janaury was
[quoted text clipped - 7 lines]
> is getting a second opinion from a very respected medical center in
> this area and also a third opinion from MD Anderson March 11.

Second and third opinions are the right thing to do.

> The
> initial conversation for the second opinion turned up something he did
[quoted text clipped - 3 lines]
> removal problematic. Before the second opinion can be offered the
> second doctor did an MRI (which we are awaiting results from tomorrow)

An endorectal MRI? That should provide useful information. A
"regular" MRI will be much less definitive.

> that he said would help him understand better the tissue makeup in the
> area they believe the cancer is growing.
[quoted text clipped - 4 lines]
> internet with very few successful results. Any help relating to any
> of the above would be greatly appreciated.

Have you tried PubMed ( http://www.ncbi.nih.gov/entrez/query.fcgi )?
When I searched [salvage prostatectomy, cryoablation] or [salvage
prostatectomy, failed cryosurgery] I got a few hits, one of which
follows.

Urology. 1995 Jun;45(6):936-41. Related Articles, Links
Comment in:
Urology. 1995 Dec;46(6):901-2; author reply 903.

Salvage radical prostatectomy after failed transperineal cryotherapy:
histologic findings from prostate whole-mount specimens correlated
with intraoperative transrectal ultrasound images.

Grampsas SA, Miller GJ, Crawford ED.

Department of Urology, University of Colorado Health Sciences Center,
Denver, USA.

OBJECTIVES. This study evaluates the potential for salvage radical
prostatectomy after failure of transrectal ultrasound (TRUS)-guided
percutaneous cryosurgical ablation of the prostate. An additional
purpose was to determine the accuracy of intraoperative TRUS to
delineate the extent of freeze destruction that results from
cryosurgery. METHODS. Six patients with biopsy-confirmed, Stage T3
prostate cancer underwent salvage radical prostatectomy 3 to 10 months
after failing prostate cryosurgery. Zones of freeze destruction
(resolving coagulative necrosis) and residual adenocarcinoma were
mapped on the coverslips of whole-mount sections. Histologically
proven zones of freeze destruction correlating to successfully treated
prostatic tissue were compared to the hypoechoic ice ball treatment
zones seen on intraoperative TRUS images. RESULTS. The whole mounts
were found to contain necrotic areas of cryodestruction that appeared
much smaller than predicted by intraoperative ultrasound. Each of the
cases also contained residual viable adenocarcinoma. All patients are
alive and clinically free of localized disease 0.5 to 12 months after
salvage radical prostatectomy. CONCLUSIONS. Salvage radical
prostatectomy offers an effective treatment option in patients who
have failed transperineal cryosurgery of the prostate. Intraoperative
TRUS predicted that the entire prostate would show freeze destruction.
Whole-mount analysis, however, revealed areas of remaining unaffected
adenocarcinoma and normal prostatic parenchyma. TRUS, therefore,
overstimates the area of prostatic tissue destroyed by extreme cold.
This finding challenges the assumption that the entire prostate is
lethally frozen when its boundaries are included within the hypoechoic
ice ball witnessed on TRUS.

Publication Types:
Clinical Trial

PMID: 7771026 [PubMed - indexed for MEDLINE]

> His son and researcher in the mold of the movie "Lorenzo's Oil"
>
> Tom
> 817-795-0958
> tomwilson64@comcast.net

It's a wonderful thing your doing, helping your dad like this...Best
wishes and good health, Ron

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Steve Kramer - 04 Mar 2004 23:24 GMT

Tom,

Cryo is itself kinda new, or at least rare. So trying to find cryo plus RRP
salvage is going to be a tough assignment. The one positive thing about
cryo is the fact that you can do it repeatedly. Based on that, I suspect
salvage RRP or salvage RT are two more options.

Signature

Prostate Cancer Survivor (so far), not a doctor
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA .1 .1 .1 .3 .4 .8
EBRT 05-07/2002 @ 47
PSA .3 .2 .2 .2 .3
Erection 05/12/2003 @ 48
HTbegins 07/21/2003 @ 48
PSA .1
Lupron 7/03, 8/03, 12/03

> It is very important for me to learn of any experiences anyone has had
> regarding this topic. Here's the story:
[quoted text clipped - 39 lines]
> 817-795-0958
> tomwilson64@comcast.net

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Matthew Emme - 29 Jun 2004 02:20 GMT

On 3/4/04 12:52 AM, in article
92569637.0403032152.1ec95bb2@posting.google.com, "Tom Wilson"
<tomwilson64@comcast.net> wrote:

> It is very important for me to learn of any experiences anyone has had
> regarding this topic. Here's the story:
[quoted text clipped - 33 lines]
> internet with very few successful results. Any help relating to any
> of the above would be greatly appreciated.

This is not a easy problem. Off the cuff I would think that external beam
radiation would be something to think about. Doing a RRP would be a mess
and would probably have a high rate of complication, but I have never gone
in and taken out a post cryo prostate.

ME

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