TRANSRECTAL ULTRASOUND-GUIDED PERCUTANEOUS RADICAL CRYOSURGICAL ABLATION OF THE PROSTATE

Background. The two major treatments for prostate cancer, radical pros tatectomy and radiation therapy, are associated with considerable morb idity and variable results. This article presents the preliminary resu lts using percutaneous radical cryosurgical ablation under ultrasound guidance to treat prostate cancer. Methods. The patient group consiste d of all patients with localized prostate cancer who underwent cryosur gery between June 1, 1990 and May 1, 1992. Patients in Group 1 were tr eated by freezing of the tumor with two cryoprobes placed multiple tim es. Group 2 patients were treated by freezing of the tumor with five c ryoprobes placed simultaneously. Cryoprobes (3 mm in diameter) were pl aced percutaneously with a transperineal approach. Cryoprobe placement and freezing were monitored using the transrectal ultrasound. Results . Of the 55 patients (68 procedures) undergoing treatment, 23 have 3 m onths of follow-up with associated biopsy (Group 1, 8 patients; Group 2, 15 patients). In Group 1, three (37.5%) patients had residual disea se. In Group 2, one (6.7%) patient had residual disease, whereas 14 (9 3.3%) patients did not. Combining both groups, 19 (82.6%) patients had no residual disease, whereas 4 (17.4%) patients had positive results on postoperative biopsy. Complications included rectal freezing, ureth rorectal fistula, sloughing urethral tissue, impotence, perineal ecchy mosis, penile edema, and ileus. Conclusions. Preliminary results indic ate that percutaneous transperineal ultrasound-guided prostate cryosur gery may be an effective treatment for prostate cancer with minimal as sociated morbidity.