|
|
| Short Contents | Full Contents | Other books NCBI |
|
|
Surgeon General Reports, SAMHSA TIPs, SAMHSA PEPs  AHCPR Archived Technology AssessmentsCryosurgery for Recurrent Prostate Cancer Following Radiation Therapy Prepared by: Martin Erlichman, M.S., Harry Handelsman, D.O., and S. Steven Hotta, M.D., Ph.D. Health Technology Assessment Number 13 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland Department of Health and Human Services Donna E. Shalala, Ph.D., Secretary Agency for Health Care Policy and Research John M. Eisenberg, M.D., Administrator June 1999 AHCPR Pub. No. 99-0004 AbstractPatients with prostate cancer are commonly treated medically or
undergo radical prostatectomy and/or radiation therapy. Radiation
therapy is usually selected for patients with local or regional
disease and patients for whom traditional surgery has failed.
The local recurrence of cancer in patients treated with radiation
therapy presents a difficult challenge regarding the selection
of further treatment options. A commonly applied treatment is
salvage prostatectomy, but it can be difficult and complicated,
with positive surgical margins occurring in as many as 50 percent
of patients and with significant postoperative morbidity. Hormonal
therapy, which is not curative, has served as an alternative to
surgery in patients who have failed to respond to radiation therapy.
Cryosurgery, the destruction of diseased tissue by freezing,
is increasingly used both as a first-line therapy and as a second-line
therapy (salvage therapy) in patients for whom radiation therapy
has failed. Recent reports suggest that cryosurgery may be a useful
alternative procedure for treating some of these patients with
recurrent cancers. Outcomes of cryosurgery are improving through
better instrumentation, surgical technique, and experience.
The available data suggest that some patients with radioresistant
cancer appear to benefit from the use of cryosurgery as a salvage
therapy. Use of this technique has resulted in biochemical disease-free
survival for varying periods of some patients who had recurrent
prostate carcinoma following radiation therapy; however, morbidity
remains high and relatively few patients have had adequate followup.
Salvage cryosurgery prospective clinical trials are warranted
and would help determine long-term survival benefits and make
possible the comparison of cryotherapy patient survival rates
with those of untreated biopsy-positive patients. The Center for Practice and Technology Assessment (CPTA) evaluates the risks, benefits, and clinical effectiveness of new or unestablished medical technologies. In most instances, assessments address technologies that are being reviewed for purposes of coverage by federally funded health programs. The CPTA assessment process includes a comprehensive review of the medical literature and emphasizes broad and open participation from within and outside the Federal Government. A range of expert advice is obtained by widely publicizing the plans for conducting the assessment through publication of an announcement in the Federal Register and solicitation of input from Federal agencies, medical specialty societies, insurers, and manufacturers. The involvement of these experts helps ensure inclusion of the experienced and varying viewpoints needed to round out the data derived from individual scientific studies in the medical literature. The CPTA analyzed and synthesized data and information received from experts and the scientific literature. The results are reported in this assessment. Each assessment represents a detailed analysis of the risks, clinical effectiveness, and uses of new or unestablished medical technologies. If an assessment has been prepared to form the basis for a coverage decision by a federally financed health care program, it serves as the Public Health Service's recommendation to that program and is disseminated widely. The CPTA is one component of the Agency for Health Care Policy and Research (AHCPR), Public Health Service, Department of Health and Human Services.
Questions regarding this assessment should be directed to:
|
||||||||||||
