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

Discussion

The optimal management for localized prostate cancer is controversial. While men with low-risk and selected intermediate-risk prostate cancer can be managed by active surveillance, the majority of men with early prostate cancer are radically treated with either surgery or radiation therapy. With better patient selection by defining the biological potential of the cancer and with improvements in technology to follow these men, active surveillance will become more widely used. For low-risk and some intermediate-risk patients, active surveillance is usually recommended since the cancer is noninvasive and has an overall survival rate comparable to other radical treatments.[2,3] Nevertheless, there is a subset of men with early cancer who will benefit from active treatment; however, they also may benefit from focal treatment of their localized cancer without subjecting them to the potential risks and complications of radical local treatment.[22]

Outcomes of the cryosurgery series show a biochemical disease-free survival rate of approximately 80% at 3 to 5 years with minimal incontinence and high potency rates. However, weaknesses from these series include the small number of patients in each series, inconsistent patient follow-up, and the use of the ASTRO definition for biochemical recurrence that was intended for use in patients treated with radiation therapy. The COLD registry, while large in numbers, represents nonstandardized treatment and a compilation of cases from multiple surgeons with variable levels of experience. Additionally, some of the cases are doubly reported as single-institution series.[17–22]

While the literature on focal cryotherapy for clinically localized prostate cancer is still limited, the number of procedures is increasing when compared to whole gland cryosurgery. In 2008, the American Urological Association published a "Best Practice Statement on Cryosurgery,"[23] which recommended that patients treated with focal cryotherapy should be included in a registry for future analysis. The report also notes the challenges in determining which patients may be offered focal cryotherapy safely. Prospective trials with adequate follow-up are needed. These trials should also include more precise criteria for selecting patients for focal cryotherapy. Finally, there is also a need to better define cancer progression.

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