Original Title: Application 1124

Authors' results and conclusions: Part A - Salvage cryotherapy for recurrent or persistent prostate cancer after radiotherapy Safety - Overall, apart from the risk of impotence and incontinence, salvage cryotherapy appears to be a reasonably safe procedure. Based on naive comparisons using evidence from a non-systematic search of the literature regarding the safety of the comparators, as well as the expert opinion of the Advisory Panel, the safety of salvage cryotherapy (+/- neoadjuvant hormone therapy(NHT)) is expected be no worse than salvage radical prostatectomy (+/- NHT), salvage HIFU (+/-NHT) or salvage brachytherapy (+/-NHT). However, due to the lack of direct comparative evidence, the relative safety of salvage cryotherapy (+/-NHT) is unknown. Effectiveness - On the basis of low-level evidence, salvage argon-based cryotherapy procedure (+/- NHT) appears to be an effective procedure for the treatment of recurrent or persistent prostate cancer after radiotherapy within a relative short follow-up period. However, the complete absence of evidence comparing the procedure against its comparators, does not allow any conclusions to be drawn in regard to comparative effectiveness. However, as it is a potentially curative treatment, cryotherapy is likely to be more effective than hormone therapy or watchful waiting, which are currently the most common management options chosen due to the lack of access to other salvage procedures. Part B - Cryotherapy for renal cancer - Safety - In general, laparoscopic cryotherapy was at least as safe as laparoscopic partial nephrectomy, as the estimated blood loss from cryotherapy was only one-quarter of that from partial nephrectomy and no significant differences in complication rates and pre/post-procedurally serum creatinine levels were observed between the two procedures. Performing cryotherapy laparoscopically reduced the occurrence of minor complications when compared to percutaneous cryotherapy. No difference was found in the safety profiles between different generations of argon-based cryotherapy for renal tumours. Effectiveness - In general, cryotherapy resulted in favourable short-term effectiveness outcomes in treatment of small renal tumours. Within follow-up periods of less than 2 years, overall survival rates and disease-specific survival rates after cryotherapy for small renal tumours were greater than 87% and consistently 100%, respectively. Relatively low rates in tumour persistence, local tumour progression, metastases and technical failure were also reported across studies. However, long-term effectiveness of cryotherapy for presumed renal cancer has not been proved. In addition, assessing cryotherapy in patients with presumed renal cancer, which might include both benign and malignant renal tumours, is likely to overestimate the real effectiveness of cryotherapy in treatment of renal cancer.

Project Status: Completed

URL for project: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1124-public

Year Published: 2009

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/4E0B5125A0BCFF8ACA25801000123B16/$File/1124_MSAC_Assessment_Report.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)