Focal Therapy of Prostate Cancer

Nicolai Hübner; Shahrokh F. Shariat; Mesut Remzi


Curr Opin Urol. 2018;28(6):550-554. 

In This Article


Cryotherapy was also originally used as whole-gland treatment, and later adapted to a focal therapy approach.[19] Cryotherapy is administered by using perineal needles, placed under ultrasound guidance to freeze the tissue. The created area of ablation (ice-ball) is monitored in real time with ultrasound as well.

Similar to HIFU, cryotherapy is associated with side effects such as urinary retention, erectile dysfunction and fistula, yet these are again very rare when focal therapy is used.

The Cryo on-line Database (COLD) Registry is a large prospectively maintained database, including patients undergoing Cryotherapy in focal, whole-gland and salvage setting. The use of focal therapy, when compared with whole-gland, has increased significantly over time (P = 0.01). The same analysis also showed a BCR-free survival rate of 75.7% at 36 months, which is similar to other focal therapy trials, yet the follow-up in the COLD Registry is longer than for most other published trials on focal therapy. The reported rates of incontinence and new onset erectile dysfunction were 8 and 41.9%, respectively.[20] Also, in cryotherapy, technical advances, such as urethral warmers, have improved the safety profile of the procedure.