CRYOSURGICAL ABLATION OF THE PROSTATE FOR LOCALIZED ADENOCARCINOMA - A PRELIMINARY EXPERIENCE

Purpose: Cryosurgical ablation of the prostate has recently become rec ognized as a therapeutic option in the treatment of localized adenocar cinoma of the prostate. To assess the efficacy of cryoablation in this disease process several centers have instituted treatment protocols. Materials and Methods: Our overall series includes 117 ultrasound guid ed percutaneous transperineal cryoablations performed on 104 patients with localized adenocarcinoma of the prostate. Followup consisted of d igital rectal examinations and measurement of prostate specific antige n levels at 3-month intervals after cryosurgery. Additionally, prostat e biopsies were obtained 3 to 6 months postoperatively. Results: Of 63 patients who underwent initial cryosurgery and followup biopsy 47 (75 %) had negative findings. Of the 16 patients with positive biopsies 10 consented to undergo a second cryosurgical ablation, and 7 of these p atients subsequently had negative followup biopsies. Therefore, our di sease-free rate at 3 months after 1 or 2 cryosurgical procedures was 9 5%. A total of 46 protocol patients in our series completed 12 months of evaluation and 40 (87%) had no evidence of disease. This same cohor t showed only minimal disease progression, with disease-free rates of 96, 93, 87 and 87% at 3, 6, 9 and 12 months, respectively. Major compl ications were infrequent. Conclusions: At 1-year followup our clinical experience shows cryoablation of the prostate to be an effective ther apy in select cases of prostatic adenocarcinoma. Long-term efficacy is still in question but, based on current disease-free rates, this ther apeutic modality merits continued clinical investigation.