Cryotherapy for localized prostate cancer today: a cryotherapist’s opinion

Dr. Aaron Katz has been practicing cryotherapy at Columbia University Medical Center in New York since 1993, so one could reasonably expect him to have a sophisticated appreciation for the pros and cons of this technique.

In a new review article entitled “Update on cryotherapy for localized prostate cancer,” Ritch and Katz have made a number of relatively conservative claims for the current role of cryotherapy, as follows:

  • “Intermediate-term data are emerging on the efficacy of cryotherapy, but direct comparison to other therapeutic modalities is difficult as the parameters for recurrence are not well defined.”
  • First-line cryotherapy,when used to treat  patients with low-risk prostate cancer, appears to have a comparable risk  for post-treatment biochemical recurrence to other treatment modalities (based on use of the ASTRO and Phoenix criteria for biochemical recurrence after radiation therapy).
  • “[H]ealth-related quality-of-life measures have improved with the most recent third-generation systems” with low rates of incontinence and urethrorectal fistula.
  • Risk for post-treatment erectile dysfunction “is high with whole gland ablation, but focal therapy may reduce these rates while still ablating unilateral cancerous tissue.”
  • “Prostate cryotherapy for localized prostate cancer is an evolving but viable therapeutic option.”
  • “Long-term data are still needed to establish a definitive role for cryosurgery in prostate cancer treatment.”

It has been about 20 years since cryotherapy started to be used seriously and regularly as a treatment for localized prostate cancer, and last year the American Urological Association finally issued a “Best Practice Policy Statement” on the role of cryotherapy in the treatment of localized disease. (Dr. Katz was one of the panel members who contributed to this policy statement.)

The “New” Prostate Cancer InfoLink is pleased to see a relatively conservative review of this type being published by a respected specialist in cryotherapy. We believe the best interests of patients are much better served by this type of assessment of the available treatments for prostate cancer (at every stage) than they are by the often overly enthusiastic articles and media releases that are often used to promote the benefits of specific types of treatment.

It seems likely to The “New” Prostate Cancer InfoLink that cryotherapy has a significant role to play in the evolution of focal therapy for prostate cancer — if we can learn to successfully identify those men who need and can be effectively and safely treated using focal therapy.

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