Laparoscopic monitoring of cryosurgical ablation of the prostate

Cryosurgical ablation of the prostate has resurfaced as a potential treatment option for organ-confined adenocarcinoma of the prostate. This study examines the temperatures achieved at the anterior prostatic capsule during the freeze-thaw cycle of transperineal cryosurgical ablation of the prostate. Additionally, as there was direct laparoscopic visualization of the prostate, frost forming outside the prostate would have been detected. Two patients underwent endoscopic extraperitoneal pelvic lymphadenectomy followed, with patients under the same anesthetic, by transperineal cryosurgical ablation of the prostate. Nadir prostatic capsular temperatures reached - 28 and - 36 degrees C, respectively, occurring approximately 13 min into the freezing phase. At these temperatures, no frost was observed endoscopically at the ventral surface of the prostate. Ice was palpated with endoscopic probes several millimeters below the ventral capsular surface. These nadir temperatures are lower than those of previous studies on cryosurgical ablation of the human prostate. Further studies need to examine the temperatures required to produce cell death and to determine whether periprostatic tissues can be treated safely and effectively for locally advanced disease.