AUA panel: Cryosurgery is an option in men with localized prostate cancer, no metatases

A panel of experts convened by AUA has determined that primary cryosurgery is an option for men who have clinically organ-confined prostate cancer of any grade with negative metastatic evaluation. Clinicians using cryosurgery are advised to review this best practice statement, which will be published in the November 2008 Journal of Urology.

The panel, chaired by Richard J. Babaian, MD, of The University of Texas, M.D. Anderson Cancer Center, Houston, carefully reviewed findings published in the medical literature from 2000 to 2008.

Dr. Babaian and colleagues noted that case selection is a primary factor. Larger prostates may make it more difficult to uniformly achieve sufficiently cold temperatures, and previous transurethral resection may be a contraindication. Cryosurgery is an option for men who either do not want to undergo or are not good candidates for radical prostatectomy because of comorbidities such as obesity or history of pelvic surgery, according to the panel.

The authors also made recommendations for maximizing the results of cryosurgery, such as using rapid freezing thermocouples to monitor temperature and a double freeze cycle, and obtaining a nadir temperature of -40C.

“In summary, a review of the historical evolution of cryosurgery provides two overriding messages, the first being that there is evidence of therapeutic benefit, and the second, that treatment-associated morbidity has been reduced as technological refinements have emerged,” the panel wrote.