The pathophysiology of thermoablation: optimizing cryoablation

Purpose of review To describe the response of prostate cancer to thermal therapies with an emphasis on cryoablative techniques. Recent findings Long-term follow-up studies demonstrate clearly the effectiveness of the use of modern cryoablative techniques in the management of prostate cancer. Recently published American Urology Association Best Practice Guidelines identify prostate cryoablation as both primary and salvage therapies. Recent findings demonstrate the effectiveness of 40 degrees C exposure as lethal to prostate cancer genotypes following a double freeze-thaw encounter. In addition, the use of adjunctive agents to sensitize the cancer to freezing is reported. Summary Thermal therapeutic options, especially cryoablation, are of growing interest for the treatment of prostatic and renal cancers. The methods of application of cryoablative therapy and the mechanisms of cell death that are attendant to the freezing-thaw encounter are clearly understood. Research focused on the development of freeze sensitizing agents that work adjunctively is of central interest in furthering the efficacy of this therapy.