Cryo- and laser surgery as new therapeutic options in patients with organ-confined prostate cancer who failed radiotherapy

In the United States about 50,000 men with organ-confined prostate cancer undergo radiation therapy each year. Depending on the source of the data and the definition of treatment failure, estimates of cancer recurrence after radiation therapy vary widely from 10% up to 50%. Patients who fail radiation have a choice of hormonal treatment, which unfortunately is only palliative, and salvage radical prostatectomy, a procedure that can be very difficult with significant comorbidities. If the patient decides for watchful waiting, tumor progression and metastatic disease are only a matter of time. Due to these clinical problems there is a need for new techniques to provide local salvage therapy. New developments in cryotherapy and endoscopic laser application such as thermocouples and ultrasound monitoring have led to decline in morbidity such as urinary incontinence. This paper presents a concise review of clinical data of salvage therapy in patients with local tumor recurrence after radiation. Only limited studies are available for laser treatment due to problems in tissue penetration and intraoperative monitoring. There is more data available dealing with cryotherapy, where argon-based cryosurgery is most common. Patients with a Gleason score < 8 and a PSA serum level less than 8.0 ng/ml seem to benefit compared to those who did not meet these criteria. Cumulative retrospective data show that with a mean follow-up of 24 months, 60% of the treated patients have a serum PSA nadir of < 0.1 ng/ml and 30% < 4.0. However, the data reviewed are primarily retrospective case series, which are particularly prone to bias. Prospective clinical studies including quality of life data are necessary in order to clarify the clinical relevance of these new techniques in salvage surgery.