Cryotherapy for localized PCa: Indications and technique

February 1, 2005

In general, we recommend cryoablation for patients with localized, high-grade tumors and higher-volume disease who are not potent or not interested in maintaining their potency.

Advances in cryoablative technology in the past decade have allowed more efficient freezing of the prostate gland while reducing damage to surrounding tissues-notably, the rectum, urethra, and external urinary sphincter. The morbidity associated with this treatment alternative has become comparable with that of other available treatment options due to the development of transrectal ultrasound guidance, urethral warmers, liquid nitrogen to gas-driven probes, and a transition from cryoprobes to the smaller cryoneedles. The availability of PSA testing has allowed for better patient selection and monitoring of cancer control following treatment.

Two cryoablation devices for prostate cancer treatment are available in the United States. The SeedNet system (Oncura) uses pressurized argon gas as the cryogen, and up to 25 cryoneedles can be used to create a conformal freezing pattern. These ultra-thin cryoneedles allow for direct transperineal needle placement through a brachytherapy-like template without making incisions or using tract dilatation and insertion kits. The iceball created by the Oncura system is approximately 2 cm in diameter.

Patient selection There are three indications for prostate cryoablation: primary therapy, salvage therapy, and palliation. In general, we recommend cryoablation for patients with localized, high-grade tumors and higher-volume disease who are not potent or not interested in maintaining their potency.

Cryoablation is also a reasonable therapeutic option for the following patients: