Cryosurgical treatment of localized prostate cancer (stages T1 to T4): preliminary results.
OBJECTIVE
We determined the posttreatment biopsy results, prostate specific antigen (PSA) levels and complications associated with cryosurgical ablation of the prostate performed for localized prostate cancer.


METHODS
Within 18 months 102 patients underwent cryosurgery as definitive therapy for localized prostate cancer. Mean patient age was 68 years and 57% had advanced local disease (stage T3 or T4). Mean preoperative PSA was 21.8 ng./ml.


RESULTS
PSA was undetectable at 6 months in 48% of patients who received no androgen deprivation therapy following cryosurgery. Of 91 patients with postoperative biopsies 77% had no evidence of cancer but 71% had benign epithelial a elements. The complication rate (excluding impotence) was 51%. Biopsy and PSA results improved with experience and changes in technique, that is double freezing, more lateral placement of cryoprobes and more aggressive freezing beyond the prostatic capsule. The most recent cohort of 77 patients had a detectable PSA rate of 23% and a positive post-cryosurgical biopsy rate of 11%. The most common serious complication encountered was bladder outflow obstruction requiring transurethral resection in 23% of the patients. Impotence occurred in 84% of patients potent preoperatively.


CONCLUSIONS
Cryosurgical ablation of the prostate can result in negative posttreatment biopsies and undetectable serum PSA levels. However, it is associated with significant side effects and the long-term durability of the procedure is unknown.
Shinohara
K
K
Department of Urology, University of California at San Francisco 94109-0738, USA.
Connolly
J A
JA
Presti
J C
JC
Carroll
P R
PR
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003452:Cryosurgery / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000628:therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*
D017430:Prostate-Specific Antigen