Cryosurgery: best practices in localized disease


The American Urology Association has just published a detailed article entitled, “Best practice statement on cryosurgery for the treatment of localized prostate cancer.” The full text of this article is available on line.

The article discusses the evidence supporting the role of cryosurgery as an effective and sufficiently safe method for the treatment of localized prostate cancer, including the fact that “The inherent treatment planning flexibility of cryosurgery lends itself to a targeted subtotal gland ablation approach for men with low-risk and/or small-volume cancers.”

Specific recommendations of the evidence review panel include the following:

  • Primary cryosurgery is an option, when treatment is appropriate, to men who have clinically organ-confined disease of any grade with a negative metastatic evaluation; high-risk patients may require multimodal therapy.

  • The role of cryosurgery in the treatment of clincial stage T3 disease is currently undetermined.

  • Salvage cryosurgery can be considered as a treatment option for curative intent in men who have failed radiation therapy; the most appropriate candidates have biopsy-proven, persistent, organ-confined prostate cancer, a PSA < 10 ng/ml, and no metastases.

  • With respect to focused use of minimally invasive cryosurgery (as opposed to treatment of the whole prostate, the panel states that in theory this approach has the potential to customize treatment and address the growing concerns of both over- and under-treatment, but that current data are insufficient to determine the incidence or consequences of treatment failure.

With respect to the current role of focused cryotherapy, the panel also states that, “While this minimally invasive technique … is attractive from a conceptual perspective, clinical experience is limited and long-term results are unavailable. The Panel’s consensus is that cases of subtotal prostate cryoablation should be collected prospectively in a database for future analysis.”

The review panel that developed this consensus statement included Dr. Brantley Thrasher, a member of the Scientific Advisory Board to The “New” prostate Cancer InfoLink.

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