Percutaneous image-guided prostate cancer treatment: cryoablation as a successful example

Prostate cancer is diagnosed in more than 200,000 men a year in the United States and an equal number in Europe. Approximately 40,000 US men per year die of the disease, second only to lung cancer as a cause of cancer mortality in men. Despite the large shadow it casts, the treatment of prostate cancer has in large part been ignored by the mainstream of interventional radiology. With the rapid growth of interventional oncology and the relative short supply of urologists available, interventional radiologists are now in a position to take a major role in treating prostate cancer. Prostate cancer is unique in that its prevalence is so high (60% of men at the age of 60 have prostate cancer in their gland) it is almost a "normal" occurrence. This has caused great controversy in the field, however, since it demands answers to the question of which patients really need treatment for this disease. Another confounding problem is that the treatments until now have been particularly morbid, leaving many men both impotent and incontinent. For this reason, a unique situation occurs where many men are now being counseled to "observe" their cancer. Interventional image-guided procedures have a potentially paradigm-changing role to play in the treatment of prostate cancer by markedly reducing the morbidity traditionally associated with management of this disease. This article reviews the current role of image-guided cryoablation of prostate cancer and the basic principles that will guide minimally invasive treatments for this disease in the future.