Background. The two major treatments for prostate cancer, radical prostatectomy and radiation therapy, are associated with considerable morbidity and variable results. This article presents the preliminary results using percutaneous radical cryosurgical ablation under ultrasound guidance to treat prostate cancer. Methods. The patient group consisted of all patients with localized prostate cancer who underwent cryosurgery between June 1, 1990 and May 1, 1992. Patients in Group 1 were treated by freezing of the tumor with two cryoprobes placed multiple times. Group 2 patients were treated by freezing of the tumor with five cryoprobes placed simultaneously. Cryoprobes (3 mm in diameter) were placed 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 months of follow‐up with associated biopsy (Group 1, 8 patients; Group 2, 15 patients). In Group 1, three (37.5%) patients had residual disease. In Group 2, one (6.7%) patient had residual disease, whereas 14 (93.3%) 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, urethrorectal fistula, sloughing urethral tissue, impotence, perineal ecchymosis, penile edema, and ileus. Conclusions. Preliminary results indicate that percutaneous transperineal ultrasound‐guided prostate cryo‐surgery may be an effective treatment for prostate cancer with minimal associated morbidity.

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A device was designed to facilitate placement of biopsy needles with computed tomographic guidance. The device consists of a hollow, clear plastic disk filled halfway with fluid and a central stem with a groove for the needle. When the device is rotated, the air-fluid level points to the corresponding angle marked on the side of the disk. In a phantom study, 17 of 20 passes were within +/- 3 degrees of the anticipated angle of entry, and the remaining three were within +/- 5 degrees. The device was also used in 14 patients; the resultant angle of entry was within +/- 3 degrees of the anticipated angle.

The success of hepatic cryosurgery is related to the visualization of the lesions and the monitoring of both the cryoprobe placement and the actual freezing procedures. This article describes the importance of a biplanar transrectal ultrasound probe in accomplishing these three things. After visualizing the liver with three different ultrasound probes (3.5 MHz convex, 5.0 MHz convex, and 5.0 linear array), the transrectal ultrasound probe is used. The two transducers in this probe provide a unique view of the liver. More importantly, the transrectal ultrasound probe provides the best imaging for placing the cryoprobes and monitoring the freezing process.

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