Cryosurgical ablation of the prostate for localized adenocarcinoma: a preliminary experience

Cryosurgical ablation of the prostate has recently become recognized as a therapeutic option in the treatment of localized adenocarcinoma of the prostate. To assess the efficacy of cryoablation in this disease process several centers have instituted treatment protocols.

Our overall series includes 117 ultrasound guided percutaneous transperineal cryoablations performed on 104 patients with localized adenocarcinoma of the prostate. Followup consisted of digital rectal examinations and measurement of prostate specific antigen levels at 3-month intervals after cryosurgery. Additionally, prostate biopsies were obtained 3 to 6 months postoperatively.

Of 63 patients who underwent initial cryosurgery and followup biopsy 47 (75%) had negative findings. Of the 16 patients with positive biopsies 10 consented to undergo a second cryosurgical ablation, and 7 of these patients subsequently had negative followup biopsies. Therefore, our disease-free rate at 3 months after 1 or 2 cryosurgical procedures was 95%. A total of 46 protocol patients in our series completed 12 months of evaluation and 40 (87%) had no evidence of disease. This same cohort showed only minimal disease progression, with disease-free rates of 96, 93, 87 and 87% at 3, 6, 9 and 12 months, respectively. Major complications were infrequent.

At 1-year followup our clinical experience shows cryoablation of the prostate to be an effective therapy in select cases of prostatic adenocarcinoma. Long-term efficacy is still in question but, based on current disease-free rates, this therepeutic modality merits continued clinical investigation.