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Is It Ready for Primetime?
Cryosurgical ablation as a treatment for prostate cancer has been FDA-approved for nearly ten years. There was never doubt that freezing kills cancer. The problem has always been damage control, which led to unacceptable complications in the 1990’s.
Currently, we believe (well supported by data) that cryosurgical ablation is a legitimate treatment option for clinically-localized prostate cancer, and no longer should it be relegated to the role of an “alternative therapy.” The technology of cryosurgery has caught up with its biology. Smaller (1.5-mm or less diameter) probes (cryoprobes) allow precise placement with little to no trauma. Ultrasound monitoring during the procedure allows live visualization of the freeze zone, and much-improved technology from Oncura, www.oncura.com, currently gives surgeons the ability to adjust and/or stop the freezing process almost instantaneously. Finally, warming catheters protect the urethra (urine channel). Based on these advances, we are achieving excellent cancer treatment with complication rates comparable to radiation options.
Current (third-generation) cryotechnology is the main basis for today’s treatment success. The freeze zone created by these probes has been carefully studied and is consistently reproducible in clinically practice. Additionally, the flame-shaped configuration of the freeze zone (iceball) correlates well with the quasi-conical shape of the prostate. Using 4-8 probes, surgeons can sculpt the prostate with sparing of the surrounding tissue. Cancer cell death occurs at 20-40 degrees below zero Celsius, and is assured by double freezing. Temperature probes are placed at the urinary sphincter, the prostate apex, and between the rectum and prostate to monitor the freezing process.
We currently offer cryosurgical ablation for men with clinically-localized prostate cancer. Most patients choosing cryosurgery are new diagnosed and are treated as primary therapy. There are a growing number of patients who have either persistent or recurrent cancer following radiation therapy being treated as salvage therapy. Complication rates are higher with salvage procedures, but still appear to be lower than radical surgery after failed radiation treatment. Finally, cryosurgical ablation at present is appropriate for men who understand they will probably not have spontaneous erections following treatment. “Focal” or “nerve-sparing” cryosurgery is currently being done at several university centers on investigational protocols.
At present, cryosurgical ablation of the prostate provides disease control and survival through five to seven year follow-up, rivaling radical surgery and radiation in the published literature. For more information, we invite you to come for a consultation with Dr. Robert Q. Hoang.
* This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information. |
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