Cryosurgical ablation of the prostate: 5-year follow-up of a prospective study

Objective: To study the complications and oncological outcome after cryosurgical ablation of the prostate (CSAP). Methods: Fifty-four patients with prostate cancer were entered into this prospective phase II trial of CSAP. Patients were followed with serum PSA determinations, follow-up biopsies at 3-6 months postoperatively and a questionnaire to assess complications. A PSA of >1 ng/ml or a positive biopsy was interpreted as progression. Results: Mean follow-up was 58.5 months. Patients needed a suprapubic catheter postoperatively for in mean 18 days. Transient penile numbness occurred in 15%. Bothersome sloughing of dead tissue was noticed by 15% of patients and 15% needed a transurethral resection. Nine patients (17%) developed strictures and five patients stone formation in the prostatic urethra. One patient developed a perennial fistula. Thirty-nine out of 43 patients reporting on potency become impotent, nine patients developed a slight stress incontinence and one severe incontinence. At median follow-up, the actuarial progression-free survival was 38.9%. Fourteen out of 50 patients biopsied (28%) had remaining cancer in their prostates. Conclusion: High complication rates in combination with poor oncological outcome has made us stop using this treatment modality. (C) 2002 Elsevier Science B.V. All rights reserved.