title: Is whole gland salvage cryotherapy effective as palliative treatment of haematuria in patients with locally advanced prostate cancer? Results of a preliminary case series.
abstract: OBJECTIVE
  Locally advanced prostate cancer may cause several complications such as haematuria, bladder outlet obstruction, and renal failure due to the ureteral obstruction. Various treatments have been suggested, including radiotherapy, antifibrinolytics, bladder irrigation with alum solution, transurethral surgery and angioembolization, none of which have proven effectiveness. In the last years cryoablation has become a valid therapeutic option for prostate cancer. In our experience we used this 'new' technique as haemostatic therapy.
  
  
  METHODS
  We selected four patients with gross haematuria affected by locally advanced hormone refractory prostate cancer, who had already been treated with primary radiotherapy. We used third-generation cryotherapy: under ultrasonographic guidance, we inserted six cryoprobes, two in each of the vascular pedicles reaching at least -60°C, and three thermometers. We then induced two freeze-thaw cycles.
  
  
  RESULTS
  After the operation the haematuria stopped in all patients and at 9-month follow up we observed a mean of four red cells (range three to five) in the urinary sediment with no evidence of bacteriuria. Prostate volume, prostate-specific antigen and postmicturition residue were significantly reduced. Qmax improved significantly too.
  
  
  CONCLUSIONS
  Our experience has given us good results with minimal intra- and postoperative complications. We think that haemostatic cryotherapy as a palliative approach for locally advanced prostate cancer could represent a valid treatment option and more consideration could be given to its use.
authors.affiliation: Department of Human Phatology, Unit of Urology, University of Messina, Via C. Valeria 1, 98125 Messina, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Magno
authors.affiliation: Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mucciardi
authors.affiliation: Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Galì
authors.affiliation: Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Pappalardo
authors.affiliation: Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lembo
authors.affiliation: Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Anastasi
authors.affiliation: Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Butticè
authors.affiliation: Department of Radiology, University of Messina, Messina, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ascenti
authors.affiliation: Unit of Urology, Kirurski Sanatorij Ljubljana Slovenia, Slovenia.
authors.forename: Franco
authors.initials: F
authors.lastname: Lugnani
keywords: cryotherapy; haematuria; haemostatic treatments; locally advanced prostate cancer (LAPC)