Critical review of the efficacy and safety of cryotherapy of the prostate

Abstract

Modern cryoablation of the prostate is a procedure that has evolved since the early 1990s into a safer and more successful treatment of adenocarcinoma of the prostate. The improvement of this technique has taken place secondary to advancement in engineering, procedure refinement, temperature monitoring, and a better understanding of physiologic events during the freezing process. Long-term results are available that demonstrate durable efficacy equivalent to other therapies in low-risk groups. In moderate to high risk groups, results point toward equal to superior results than other standard therapies. New ideas on potency preservation using vacuum erection devices have improved men's return to function over the course of the postoperative year. Early morbidity issues, such as fistula formation and incontinence, have become much less problematic, with results between 0% and 1% in some series. Cryoablation of the prostate now offers significantly improved outcomes with a parallel decrease in morbidity.

Successful Use of Absorbable Hydrogel Rectal Spacers (SpaceOAR) Before Salvage Radiation Therapy After Previous Prostate Cryotherapy

“…Prostate cryoablation is a localized treatment option for selected patients with localized prostate cancer. 3,15,16 Some patients develop locally recurrent disease following definitive cryoablation, 6 and are often candidates for additional local treatment with curative intent.…”

Ultrasound probe positioning to minimize the risk of recto‐urethral fistula during cryosurgical ablation of prostate cancer

“…Older series reported the risk of RUF to be as high as 3.3%[2,7], but most recent series show RUF to be less common [8]. The approval of the urethral warming device was reported to have a significant impact on the risk of urethral slough and RUF [9,10]. Nevertheless, historical concern about RUF persists.…”