CRYOSURGICAL TREATMENT OF LOCALIZED PROSTATE-CANCER (STAGES T1 TO T4)- PRELIMINARY-RESULTS

Purpose: We determined the posttreatment biopsy results, prostate spec ific antigen (PSA) levels and complications associated with cryosurgic al ablation of the prostate performed for localized prostate cancer. M aterials and Methods: Within 18 months 102 patients underwent cryosurg ery as definitive therapy for localized prostate cancer. Mean patient age was 68 years and 57% had advanced local disease (stage T3 or T4). Mean preoperative PSA was 21.8 ng./ml. Results: PSA was undetectable a t 6 months in 48% of patients who received no androgen deprivation the rapy following cryosurgery. Of 91 patients with postoperative biopsies 77% had no evidence of cancer but 71% had benign epithelial elements. The complication rate (excluding impotence) was 51%. Biopsy and PSA r esults improved with experience and changes in technique, that is doub le freezing, more lateral placement of cryoprobes and more aggressive freezing beyond the prostatic capsule. The most recent cohort of 77 pa tients had a detectable PSA rate of 23% and a positive post-cryosurgic al biopsy rate of 11%. The most common serious complication encountere d was bladder outflow obstruction requiring transurethral resection in 23% of the patients. Impotence occurred in 84% of patients potent pre operatively. Conclusions: Cryosurgical ablation of the prostate can re sult in negative posttreatment biopsies and undetectable serum PSA lev els. However, it is associated with significant side effects and the l ong-term durability of the procedure is unknown.