Cryosurgical ablation for prostate cancer: a current review

The available data on the efficacy of cryosurgery are still too immature to recommend this as a comparable option to radical surgery in the younger patient (< 72 years old) with organ-confined disease and at least a 10- to 15-year life expectancy. The available 3-month and 1-year positive biopsy figures of 10% to 20% are inversely comparable to the 10-year 80% to 90% disease-free survivals in contemporary radical prostatectomy series. While we wait for survival data to mature, it is unlikely that 10% to 20% local recurrence rates will translate into 80% to 90% disease-free survival rates. Only the data from the Crittendon Hospital group, which reports positive biopsies at 1 year of 3% to 4%, deserves special attention. Their protocol of optimal presurgical androgen ablation, use of thermosensors, and use of 2 to 3 freeze cycles may direct the way to a better cryosurgical technique. Conversely, the 2 to 8 months of presurgical androgen deprivation may just be prolonging the appearance of cryo-resistant cells. Regarding clinical stage C disease, the data looks promising with similar results as in organ-confined disease with a 10% to 20% positive biopsy rate at 3 months. One has to be cautious about what is really a stage C lesion, and comparison of preoperative PSA values enhance the comparisons between series. Overall, if the 1-year local recurrence rate does not exceed 30%, recommending cryosurgery as a viable option seems reasonable.(ABSTRACT TRUNCATED AT 250 WORDS)