Counseling patients about cryotherapy for prostate cancer in the information age

Patients diagnosed with prostate cancer who elect to pursue active treatment of their disease must choose among the many available treatment alternatives. Several treatment options now exist for similar stage disease (clinical T1-3N0M0), including radical prostatectomy, external beam radiotherapy, prostate brachytherapy, cryosurgical ablation of the prostate (CSAP), and various combination therapies. This article focuses principally on the authors' philosophy regarding the role of CSAP in the treatment of clinically localized prostate cancer and is written to aid patients in their treatment decision. There is limited information on CSAP in the standard resources, such as the Internet and books frequently used by patients to make their treatment decisions. This article can serve as a resource on the evolution, results, and complications of CSAP that are reported. Cryosurgical ablation of the prostate has a role in the primary treatment of men with high risk, clinically localized prostate cancer (defined as prostate-specific antigen >10, Gleason score > or =7, or clinical stage > or =cT2B). Cryosurgical ablation of the prostate (occasionally followed by external beam radiotherapy) appears to offer improved rates of cancer control over other types of single or combination therapies for this high risk prostate cancer, and is associated with an acceptable side effect profile. Cryosurgical ablation of the prostate should also be the treatment of choice for men with recurrent local disease after external beam radiotherapy.