Is focal cryotherapy appropriate for localized disease?

A review article by Polascik et al. in this month’s issue of Oncology addresses the potential of third-generation cryosurgical technology as a method to treat localized prostate cancer by freezing only targeted areas of the gland as opposed to the entire prostate.

Some experienced cryosurgeons have already been trying out this technique on selected patients. However, Polascik and his colleagues argue that:

Although targeted cryoablation of a single cancer focus may be an attractive concept, we currently do not have sufficient basic science data regarding the biology of prostate cancer heterogeneity nor accurate genetic or molecular markers of early tumorigenesis. Furthermore, the lack of accurate imaging modalities and limitations of image-guided prostate biopsy technology prevent one from defining all small prostate cancer lesions within the prostate or predicting behavior and aggressiveness so that a clinically significant index lesion amenable to cryoablation can be distinguished. Inadvertently excluding a lesion from treatment that may potentially become clinically aggressive over time might compromise the concept of focal therapy if proper surveillance mechanisms are not in place.

Their review provides an excellent update on the current state of evolution of cryotherapy and its applications in the first-line treatment of localized prostate cancer. The authors’ commentary is largely endorsed by the two complementary sets of editorial comments (one by Coleman and Scardino and the other by Maroni and Crawford).

The “New” Prostate Cancer InfoLink recommends this review as background reading for knowledgable patient advocates and “mentors.” It will also be useful for any patient who is interested in learning more about the possibility of focal cryotherapy for localized disease.

4 Responses

  1. Dr. Onik and others doing focal procedures are working from 3-D mapping biopsies – “the prostate is biopsied every 5 millimeters throughout it’s whole volume” . The brief at: (download PDF by pressing “Link”) indicates that this is as effective as a whole mount following RP in detecting and staging cancer.

  2. I am pleased to see that on his web site Dr. Al Barqawi clearly states that, “This is a novel research project …” and is not trying to present focal cryotherapy as “the latest thing.”

  3. Dr. Gary Onik says: “Our results, and now those of other investigators indicate that a “lumpectomy” approach for men is a viable treatment for prostate cancer. “

  4. “Viable treatment” is fine … but the scientists I trust would still add the word “investigational” into that sentence … as in “a viable investigational treatment.”

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