BACKGROUND The authors report their experience with cryosurgical ablation of the prostate in men with high‐risk features for prostate carcinoma who were unwilling to undergo radical surgery or radiation therapy. METHODS Between January 1998 and April 2002, 65 men underwent primary cryosurgery for prostate carcinoma with high‐risk features. All patients had biopsy‐proven prostate carcinoma without evidence for metastatic disease on magnetic resonance images, computed tomography scans, or radionuclide images of bones. High‐risk parameters were defined as either a prostate‐specific antigen (PSA) level ≥ 10 ng/mL, or a Gleason sum score ≥ 8, or both. Patients who had undergone prior surgery, radiation therapy, or cryoablation for prostate carcinoma were excluded from the study. Patients were monitored with physical examination and PSA screening every 3 months and with radiologic imaging when indicated. RESULTS The median patient age was 72 years (range, 41–86 years), and t he median follow‐up was 35 months (range, 4–77 months). There were 2 patients (3.1%) with rectal pain and incontinence. Durable PSA biochemical disease‐free survival was noted in 83.3% of patients according to the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria. A 6‐year Kaplan–Meier analysis revealed an 81.7% ASTRO survival probability as well as PSA nadir < 4.0 ng/mL and PSA nadir < 1.0 ng/mL projections of 50% and 35%, respectively. One of 8 postcryosurgery biopsies (12.5%) were positive. No patient had progressed at last follow‐up, and the overall survival rate was 100%. CONCLUSIONS Cryoablation was a feasible treatment option in patients with organ‐confined prostate carcinoma who had high‐risk features. Longer follow‐up will be necessary to determine the effectiveness of this approach. Cancer 2005. © 2005 American Cancer Society.

Purpose: The treatment of urinary tract stones in obese patients may differ from the treatment of non-obese patients and their success rate varies. Our objective was to compare ureteroscopic treatment outcomes of ureteral and renal stones, stratified for stone size and location, between overweight, obese and non-obese patients. Materials and Methods: Charts were reviewed for 500 consecutive patients presenting at our institution for renal and ureteral stones. A total of 107 patients underwent flexible or semi-rigid ureteroscopy with Ho:YAG laser lithotripsy and met criteria for review and analysis. Results: Overall, initial stone-free rates were 91%, 97%, and 94% in normal, overweight and obese individuals respectively. When compared to non-obese patients, there were no significant differences (p value = 0.26; 0.50). For renal and proximal ureteral stones, the stone-free rate in overweight and obese individuals was 94% in both groups; and a stone-free rate of 100% was found for distal stones, also in both groups. Conclusions: Ureteroscopic treatment of stones in obese and overweight patients is an acceptable treatment modality, with success rates similar to non-obese patients.

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