Focal Cryotherapy in the Treatment of Localized Prostate Cancer

Huy D. Nguyen, BS; Bryan J. Allen, MD; Julio M. Pow-Sang, MD

Disclosures

Cancer Control. 2013;20(3):177-180. 

In This Article

Abstract and Introduction

Abstract

Background: The management choice for newly diagnosed localized prostate cancer presents a challenge to both the physician and the patient. Traditionally, surgery and radiation therapy have been the most commonly recommended options. More recently, active surveillance is recommended as the preferred management choice for a subset of men with localized, low-risk cancer. Recent reports also suggest that focal cryotherapy may be considered as a management option for selected cases of clinically localized prostate cancer.

Methods: A review of the literature on focal cryotherapy from 2002 to 2012 was performed. Outcomes on cancer control, complications, and quality of life were extracted and assessed.

Results: The biochemical disease-free survival at 5 years is comparable to whole gland treatment modalities. Complications are minimal and comparable with other local treatment modalities.

Conclusions: Focal cryotherapy is safe and effective, and it may improve failure rates in men who initially pursue active surveillance protocols. Early outcomes with cancer control are encouraging.

Introduction

PSA screening has led to a dramatic increase in the incidence of prostate cancer, with the majority of cases currently diagnosed at earlier, clinically favorable stages.[1] Since prostate cancer grows slowly, men diagnosed with this disease might die of causes unrelated to their cancer. Thus, active surveillance is a valid option for men who fit the recommended criteria and do not want to consider any type of invasive or radical treatments. While studies on active surveillance have shown a 10-year overall survival rate of approximately 80%, there is still a lingering concern of allowing a potentially curable cancer to progress to incurable disease before establishing definitive treatment.[2,3] However, a recent prostate intervention vs observation trial (PIVOT trial) by Wilt et al[4] indicated that for men with low-risk tumors, no distinct differences were seen in overall or cancer-specific survival benefits when comparing radical prostatectomy with active surveillance. The PIVOT trial reported that 171 of 364 men (47%) in the radical prostatectomy group died, while 183 of 367 men (49%) in the observation group died. A strategy of incorporating focal therapy as definitive treatment for selected men with focal disease and clinically significant cancer may reduce the number of men who will require treatment while on active surveillance. Considered a minimally invasive treatment, questions related to focal therapy include patient selection, evaluation of treatment success, and the best technology to use. The technology most commonly available for focal therapy is cryosurgery. This technology allows for treatment of selected areas within the prostate in which cancer is present while sparing noncancerous areas through a transperineal, percutaneous approach using ultrasound imaging.

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