The first speaker of the afternoon was Dr. Fred Lee who titled his talk “The Iceman Cometh” – Cryosurgery. Dr. Lee started off by telling us that he was diagnosed with prostate cancer in 1984, a Gleason grade 3 + 5 with metastasis to the lymph nodes. He started his slide presentation off with pictures of his family and told us a little about each. He is very proud of his children.
Dr. Lee told us that PSA and TRUS have about the same sensitivity and specificity. The DRE is less sensitive.
He explained that intracellular ice kills the cell and ice will also kill the blood supply. He showed us a picture of the ice forming probe and explained that it will form an ice ball 1” wide and 2” long.
Dr. Lee places 4 temperature probes around the prostate, and will use 6 – 8 ice forming probes in the prostate depending on where the cancer is located. Cryosurgery kills all of the cancer cells plus all of the normal prostate cells.
He said that none of his patients will be potent after treatment and early on 1% had a fistula and 1% were incontinent. He is not finding these side effects happening even that much now. In 2000 he had done 713 cases, and now has done on the plus side of 900.
Dr. Lee said that he can treat all stages of prostate cancer. He told us of treating a man with a stage T3 cancer. The gentleman died a year later of other causes and the autopsy could not find any sign of prostate cancer.
Dr. Lee said that a man that has had external beam radiation and has shown signs of failure should have a biopsy as early as possible. He said that 41% of biopsies 3 years after radiation will show no radiation effect on the cancer and it will generally be much more aggressive with a higher Gleason than when first discovered.
Cryo can be done a second time and can be done for failed radiation procedures. When asked about doing it to just a small area where the cancer is he explained that there are small foci of PIN in the prostate and these spots will progress into prostate cancer in time.
Neil H. Bander, M.D. of New York-Presbyterian Hospital, Memorial Sloan-Kettering Cancer Center. was the next speaker. Dr. Bander titled his talk Treatment of Prostate Cancer – The Magic Bullet. His talk addressed his work with monoclonal antibodies.