CRYOABLATION OF LOCALIZED PROSTATE-CANCER - EXPERIENCE IN 48 CASES, PSA AND BIOPSY RESULTS

Objectives: As the first German center to perform perineal cryoablatio n of localized prostate cancer, we present our experience in a series of 48 consecutive patients. Methods: 7 patients staged T-1, 21 with T- 2 disease and 20 patients with T-3 tumor were treated. 62.5% of the pa tients received neoadjuvant hormonal downsizing. Follow-up ranged from 4 to 27 months with a median of 15 +/- 5.7 months. Results: Positive control biopsies after 6 months were obtained in 0% of T-1 tumors, 16. 7% of T-2 tumors and 26.7% of T-3 tumors. Prostate-specific antigen pe rsistence above 1 ng/ml was diagnosed in 14.3, 33.3, and 40%, respecti vely. Complications were acceptable. 22.9% of the patients had prolong ed urinary retention, requiring transurethral resection in 5 patients (10.4%) to relieve obstruction. In 5 cases (10.4%) incontinence was fo und, in 2 of these patients mild urge incontinence declined over time, in 3 cases moderate to severe stress incontinence developed. Two of t hese patients were pretreated with radiotherapy. No fistulae were note d. Conclusions: Cryoablation of the prostate is not a substitution for radical prostatectomy but enables the surgeon to perform a radical cu rative procedure in patients unfit for other radical forms of treatmen t or unwilling to undergo these. Long-term follow-up and prospective s tudies are necessary to define the clinical significance of this proce dure.