Cryotherapy and other ablative techniques for the initial treatment of prostate cancer
- Louis L Pisters, MD
Louis L Pisters, MD
- The University of Texas School of Medicine
- MD Anderson Cancer Center
- Philippe E Spiess, MD, MS, FRCSC
Philippe E Spiess, MD, MS, FRCSC
- Associate Professor
- The University of South Florida
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Ablation techniques, including cryotherapy and high-intensity focused ultrasound (HIFU), have been used to destroy tissue, either by freezing or by generating local thermal energy, and thereby treat prostate cancer. These ablation techniques can be applied to the entire prostate gland or to only the part of the gland thought to be involved with cancer.
The role of ablation techniques as an alternative to radical prostatectomy or radiation therapy (RT) for the definitive treatment of prostate cancer remains uncertain. Potential advantages in men with localized disease include the ability to destroy cancer cells using a relatively noninvasive procedure, as well as sparing normal tissue. These procedures are associated with minimal blood loss and less pain than surgery, and there is a more rapid posttreatment convalescence.
Whether the long-term outcomes are equivalent to those with definitive surgery or RT is uncertain, however. Additional experience and longer follow-up are required to compare the rate of disease control and side effects profiles with other treatment modalities.
The role of ablative techniques for the initial treatment of localized prostate cancer as well as its use in the salvage setting is discussed here. Standard treatment options for early prostate cancer and the approach to patients with local recurrence after RT are discussed separately. (See "Initial approach to low- and very low-risk clinically localized prostate cancer" and "Rising serum PSA after radiation therapy for localized prostate cancer: Salvage local therapy".)
Cryotherapy is a treatment modality for localized prostate cancer in which freezing is used to destroy tumor cells. Potential advantages of cryoablation compared with other therapeutic options in men with localized prostate cancer include:
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- Primary therapy
- - Efficacy
- - Focal cryotherapy
- Cryotherapy for rising PSA after RT
- - Pain and swelling
- - Incontinence and outflow obstruction
- - Fistulas and strictures
- - Impotence
- Salvage therapy
- HIGH-INTENSITY FOCUSED ULTRASOUND
- SURVEILLANCE AFTER TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS