Short-Term Cancer Control After Primary Cryosurgical Ablation for Clinically Localized Prostate Cancer Using Third-Generation Cryotechnology

Abstract

Percutaneous perineal cryoablation of the prostate is a promising technique in the treatment armamentarium for clinically localized prostate carcinoma. We report our initial experience using a transrectal ultrasound-guided, third-generation, argon/helium cryosurgical system. From January 2002 to July 2005, 50 men underwent primary cryosurgery for clinically localized prostate carcinoma. The median patient age was 68 years (range 50 to 83), and the median follow-up period was 18 months (range 3 to 43). According to the D'Amico risk stratification system, 36 patients (72%) had low-risk, 9 (18%) had intermediate-risk, and 5 (10%) had high-risk prostate cancer. All patients underwent a dual freeze-thaw cycle using third-generation cryotechnology with ultrathin 17-gauge cryoneedles. The prostate-specific antigen (PSA) level for all patients at the last follow-up visit was less than 0.5 ng/mL in 45 patients (90%) and 0.5 ng/mL or more in 5 (10%). Two patients had persistent prostate cancer confirmed by prostate biopsy and were treated with salvage cryotherapy or external beam radiotherapy. Three other patients had an elevated PSA level after cryotherapy despite negative posttreatment biopsies and a metastatic evaluation. Of these 3 patients, 2 had their postcryotherapy PSA level normalize, and 1 patient, with intermediate-risk disease preoperatively, had a consistent increase in PSA up to 1.2 ng/mL. The overall survival rate was 100%. Cryoablation of the prostate is a feasible and safe treatment option in patients with organ-confined prostate cancer. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.