Image-guided prostate cryosurgery: state of the art.
BACKGROUND
Cryosurgery was first used to treat prostate cancer in the early 1970s but it was not until 1993, when the results from percutaneous ultrasound-guided cryosurgery were published, that the potential advantages of this treatment became apparent. Changes in equipment and techniques have improved the results of cryosurgery, in both tumor control and lower morbidity.


METHODS
The author has reviewed data of his own and those of others concerning the changes in techniques employed and outcomes from prostate cryosurgery.


RESULTS
Ultrasound-guided percutaneous transperineal placement of the cryoprobes allows monitoring of freezing in real time. Monitoring temperature at critical locations, separating the rectum and prostate by saline injection, and using argon gas rather than liquid nitrogen-based equipment have improved results and lowered complication rates. The technique produces outcomes similar to those obtained with brachytherapy and three-dimensional conformal radiation therapy.


CONCLUSIONS
Advantages of cryosurgery include the ability to re-treat patients without added morbidity and to treat salvage postradiation patients with acceptable results and morbidity. The recent demonstration that "nerve-sparing" cryosurgery is possible suggests that cryosurgery may be used more often.
Onik
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Celebration Health/Florida Hospital, Center for Surgical Advancement, Suite A 280, 400 Celebration Place, Celebration, FL 34747, USA. OnikCryo@aol.com
D003452:Cryosurgery / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography