Cryosurgical treatment of localized prostate cancer (stages T1 to T4): Preliminary results

Purpose: 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. Materials and 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 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.