Role of Image-Guided Focal Cryoablation in Localized Prostate Cancer

Abstract

Prostate cancer is the most common non-cutaneous malignancy in men, with the majority of newly diagnosed clinical scenarios eligible for active surveillance. However, there may be psychological ramifications associated with living with an untreated malignancy. Furthermore, recent reports show long-term progression exceeds 50% even for low-risk disease. Given the morbidity of traditional whole-gland prostate cancer therapies further advancements are necessary to maximize cure and minimize treatment side effects. Advances in multiparametric MRI has enabled a paradigm shift not only in the detection of clinically significant disease, but also toward more specific disease localization. While traditional treatments for prostate cancer involve whole-gland treatment, contemporary MRI technology allows for consideration of focal ablation via various technologies. This review details focal cryoablation for primary and salvage prostate cancer treatments and compares its efficacy to other treatment methods, including brachytherapy, external beam radiation, and high intensity focused ultrasound. The use of focal cryoablation as a primary treatment has shown promising oncologic outcomes, similar to that of whole-gland cryoablation, but with better functional outcomes. Focal cryotherapy as a salvage treatment has mixed results regarding efficacy and warrants further study. When compared to other focal treatments, cryotherapy leads to similar, or better, oncologic control outcomes. In addition, the review details the considerations for adjunct therapies and future applications to enhance the precision accuracy of current focal cryoablation techniques.