Cryosurgery for Localized Prostate Cancer

Most men currently diagnosed with localized prostate cancer are likely to have the disease eradicated by one of the available treatment modalities, but the focus on health-related quality of life associated with treatment has intensified. In 2007, the American Urological Association (AUA) released guidelines for the management of clinically localized prostate cancer. This guideline, however, did not address the role of cryosurgery for treatment of the disease because of insufficient long-term efficacy data on metastasis-free, prostate-cancer specific or overall survival. In the November 2008 Journal of Urology, the AUA released a new best practice statement on cryosurgery for the treatment of localized prostate cancer. “This is the first time the AUA has released official guidance on this treatment modality,” says Richard J. Babaian, MD, who chaired the panel that published the statement. According to the AUA guidelines, several investigations have reported the efficacy and morbidity of cryosurgery for the disease. “Prostate cryosurgery has been found to result in acceptable outcomes with regard to health-related quality of life,” says Dr. Babaian. “It has been associated with reduced costs when compared with other local therapeutic options.” Studies have also shown that short-term PSA relapse-free survival outcomes following cryoablation of the entire prostate are comparable to that of radiation therapy in men with intermediate- and high-risk disease. Cryosurgery Options According to the AUA best practice statement, cryosurgery can be used as primary therapy or salvage therapy (Table 1). The minimally invasive treatment involves freezing cancerous tissue. As a result of this process, tumors are destroyed. Therma probes are placed into the prostate, where a controlled freezing-thawing process ensues. Clinicians must monitor patients...