Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience

• Published in: The Journal of urology Vol. 170; no. 4 Pt 1; p. 1126
• Main Authors: Han, Ken-Ryu, Cohen, Jeff K, Miller, Ralph J, Pantuck, Allan J, Freitas, Danielo G, Cuevas, Carlos A, Kim, Hyung L, Lugg, James, Childs, Stacy J, Shuman, Barry, Jayson, Maury A, Shore, Neal D, Moore, Yan, Zisman, Amnon, Lee, Joe Y, Ugarte, Roland, Mynderse, Lance A, Wilson, Torrence M, Sweat, Susan D, Zincke, Horst, Belldegrun, Arie S
• Format: Journal Article
• Language: English
• Published: United States 01.10.2003
• Subjects: Aged; Aged, 80 and over; Cryosurgery - adverse effects; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications - epidemiology; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery
• ISSN: 0022-5347
• DOI: 10.1097/01.ju.0000087860.52991.a8

Cryosurgical ablation of the prostate is 1 approach to the treatment of localized prostate cancer. Third generation cryosurgery uses gas driven probes that allow for a decrease in probe diameter to 17 gauge (1.5 mm). The safety, morbidity and preliminary prostate specific antigen (PSA) results of 122 cases are reported. A total of 106 patients have undergone percutaneous cryosurgery using a brachytherapy template with at least 12 months of PSA followup. Immediate and delayed morbidities were evaluated. PSA results at 3 and 12 months were recorded, and failure was defined as the inability to reach a nadir of 0.4 ng/ml or less. Complications in patients undergoing primary cryosurgery included tissue sloughing (5%), incontinence (pads, 3%), urge incontinence/no pads (5%), transient urinary retention (3.3%) and rectal discomfort (2.6%). There were no cases of fistulas or infections. Postoperative impotence was 87% in previously potent patients. For patients who underwent salvage cryosurgery there were no fistulas reported and 2 (11%) patients required pads after salvage cryosurgery. A total of 96 (81%) patients achieved a PSA nadir of 0.4 ng/ml or less at 3 months of followup, while 79 of 106 (75%) remained free from biochemical recurrence at 12 months. A total of 42 (78%) low risk patients (Gleason score 7 or less and PSA 10 or less) remained with a PSA of 0.4 ng/ml or less at 12 months of followup, compared to 37 (71%) high risk patients. All patients were discharged within 24 hours. After a followup of 1 year 3rd generation cryosurgery appears to be well tolerated and minimally invasive. The use of ultrathin needles through a brachytherapy template allows for a simple percutaneous procedure and a relatively short learning curve. A prospective multicenter trial is ongoing to determine the long-term efficacy of this technique.