Definitive prostate RT after failed cryoablation

[Pewl]

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Has anyone here had any personal experience with treating a gleason 7 intermediate risk guy with definitive RT after he failed cryoablation as an initial treatment? I'm not sure why this guy was given cryotherapy as initial treatment. Is there any reliable data out there on safety and efficacy in this scenario?

 

[Brim]

I've treated such patients a number of times. I treat similarly to other definitive patients, same dose. Not seen any problems.

 

[seper]

Treated a few patients, which were OK, but I'm not aware of published data.

 

[Chartreuse Wombat]

Has anyone here had any personal experience with treating a gleason 7 intermediate risk guy with definitive RT after he failed cryoablation as an initial treatment? I'm not sure why this guy was given cryotherapy as initial treatment. Is there any reliable data out there on safety and efficacy in this scenario?

Choi M, Kim CR, Hung AY. Salvage intensity-modulated radiation therapy for locally recurrent prostate cancer after cryotherapy. Clin Genitourin Cancer. 2013
Jun;11(2):85-8. doi: 10.1016/j.clgc.2012.09.003. Epub 2012 Oct 5. PubMed PMID: 23041454.

Hepel JT, MacAusland SG, Long JP, Wazer DE, DiPetrillo T. Intensity-modulated radiotherapy of the prostate after cryotherapy: initial experience. Urology. 2008
Dec;72(6):1310-4; discussion 1314. doi: 10.1016/j.urology.2008.01.079. Epub 2008 May 27. PubMed PMID: 18502482.

 

[medgator]

Has anyone here had any personal experience with treating a gleason 7 intermediate risk guy with definitive RT after he failed cryoablation as an initial treatment? I'm not sure why this guy was given cryotherapy as initial treatment. Is there any reliable data out there on safety and efficacy in this scenario?

It's because the urologist makes $$$$ when they cryo, not when they send it to you for XRT

 

[Reaganite]

i'm not sure why this guy was given cryotherapy as initial treatment.

This line made me chuckle 🙂. Same reason a med onc will do 4 lines of chemo for a painful bone met before he will send to you for palliative XRT.

 

[Reaganite]

careful now......you know what they say about glass houses

I hear ya, although I think we are more guilty of over-utilization of expensive treatments (i.e. too much IMRT, increased fractionation, etc.) than witholding necessary care to patients. Whether you do 8 in 1 vs. 30 in 10 for a bone met, you're still benefiting the patient clinically. Offering someone cryo upfront or refusing to send to RT for a bone met is clinically negligent and harms the patient. I'd like to think there is less of that in our specialty than other specialties, and at least from my experiences in multiple tumor boards, that's indeed what I have seen.

 

[medgator]

careful now......you know what they say about glass houses

Except XRT has endorsement for primary treatment of prostate ca from multiple medical societies and guidelines.

Even the AUA afaik doesn't recognize cryo as a standard primary treatment. These surgeons should either be cutting it out or sending it for xrt