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Cryotherapy and other ablative techniques for the initial treatment of prostate cancer

Louis L Pisters, MD
Philippe E Spiess, MD, MS, FRCSC
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


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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Literature review current through: Nov 2017. | This topic last updated: Oct 18, 2017.
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  1. Onik GM, Cohen JK, Reyes GD, et al. Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer 1993; 72:1291.
  2. Rubinsky B. The freezing process and mechanism of tissue damage. In: Percutaneous Prostate Cryoablation, Onik GM, Rubinsky B, Watson F, Albin RJ (Eds), Quality Medical Publishing, St. Louis 1995. p.49.
  3. Whittaker DK. Mechanisms of tissue destruction following cryosurgery. Ann R Coll Surg Engl 1984; 66:313.
  4. Mazur P. Cryobiology: the freezing of biological systems. Science 1970; 168:939.
  5. Larson TR, Rrobertson DW, Corica A, Bostwick DG. In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes. Urology 2000; 55:547.
  6. Carroll PR, Lee Kl, Fuks ZY, Kantoff PW. Cancer of the prostate. In: Principles and Practice of Oncology, 6th, Devita VT Jr, Hellman S, Rosenberg SA (Eds), Lippincott, Williams and Wilkins, Philadelphia 2000. p.1456.
  7. Schmidt JD, Doyle J, Larison S. Prostate cryoablation: update 1998. CA Cancer J Clin 1998; 48:239.
  8. Perrotte P, Litwin MS, McGuire EJ, et al. Quality of life after salvage cryotherapy: the impact of treatment parameters. J Urol 1999; 162:398.
  9. Chang Z, Finkelstein JJ, Ma H, Baust J. Development of a high-performance multiprobe cryosurgical device. Biomed Instrum Technol 1994; 28:383.
  10. Koch MO, Gardner TA. Thermal-based treatment options for localized prostate cancer. Curr Treat Options Oncol 2005; 6:379.
  11. Lee F, Bahn DK, Badalament RA, et al. Cryosurgery for prostate cancer: improved glandular ablation by use of 6 to 8 cryoprobes. Urology 1999; 54:135.
  12. Han KR, Cohen JK, Miller RJ, et al. Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol 2003; 170:1126.
  13. Han KR, Belldegrun AS. Third-generation cryosurgery for primary and recurrent prostate cancer. BJU Int 2004; 93:14.
  14. Sesia G, Ferrando U, Fontana G, et al. Palliative cryotherapy in inoperable prostate carcinoma. Recent Results Cancer Res 1977; :84.
  15. Chin JL, Ng CK, Touma NJ, et al. Randomized trial comparing cryoablation and external beam radiotherapy for T2C-T3B prostate cancer. Prostate Cancer Prostatic Dis 2008; 11:40.
  16. Donnelly BJ, Saliken JC, Brasher PM, et al. A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer. Cancer 2010; 116:323.
  17. Chin JL, Al-Zahrani AA, Autran-Gomez AM, et al. Extended followup oncologic outcome of randomized trial between cryoablation and external beam therapy for locally advanced prostate cancer (T2c-T3b). J Urol 2012; 188:1170.
  18. Gestaut MM, Cai W, Vyas S, et al. Low-Dose-Rate Brachytherapy Versus Cryotherapy in Low- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 98:101.
  19. Jones JS, Rewcastle JC, Donnelly BJ, et al. Whole gland primary prostate cryoablation: initial results from the cryo on-line data registry. J Urol 2008; 180:554.
  20. Levy DA, Ross AE, ElShafei A, et al. Definition of biochemical success following primary whole gland prostate cryoablation. J Urol 2014; 192:1380.
  21. Donnelly BJ, Saliken JC, Ernst DS, et al. Prospective trial of cryosurgical ablation of the prostate: five-year results. Urology 2002; 60:645.
  22. Cohen JK, Miller RJ, Rooker GM, Shuman BA. Cryosurgical ablation of the prostate: two-year prostate-specific antigen and biopsy results. Urology 1996; 47:395.
  23. Spiess PE, Given RW, Jones JS. Achieving the 'bifecta' using salvage cryotherapy for locally recurrent prostate cancer: analysis of the Cryo On-Line Data (COLD) registry data. BJU Int 2012; 110:217.
  24. Crawford ED, Barqawi A. Targeted focal therapy: a minimally invasive ablation technique for early prostate cancer. Oncology (Williston Park) 2007; 21:27.
  25. Mouraviev V, Mayes JM, Sun L, et al. Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer. Cancer 2007; 110:906.
  26. Eggener SE, Scardino PT, Carroll PR, et al. Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 2007; 178:2260.
  27. Koch MO. Focal prostate therapy. J Urol 2008; 179:2091.
  28. Yoon GS, Wang W, Osunkoya AO, et al. Residual tumor potentially left behind after local ablation therapy in prostate adenocarcinoma. J Urol 2008; 179:2203.
  29. Isbarn H, Karakiewicz PI, Vogel S, et al. Unilateral prostate cancer cannot be accurately predicted in low-risk patients. Int J Radiat Oncol Biol Phys 2010; 77:784.
  30. Catto JW, Robinson MC, Albertsen PC, et al. Suitability of PSA-detected localised prostate cancers for focal therapy: experience from the ProtecT study. Br J Cancer 2011; 105:931.
  31. Beauval JB, Ploussard G, Soulié M, et al. Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study. Urology 2012; 80:656.
  32. Ward JF, Jones JS. Focal cryotherapy for localized prostate cancer: a report from the national Cryo On-Line Database (COLD) Registry. BJU Int 2012; 109:1648.
  33. Badalament RA, Bahn DK, Kim H, et al. Patient-reported complications after cryoablation therapy for prostate cancer. Arch Ital Urol Androl 2000; 72:305.
  34. Cox RL, Crawford ED. Complications of cryosurgical ablation of the prostate to treat localized adenocarcinoma of the prostate. Urology 1995; 45:932.
  35. de la Taille A, Hayek O, Benson MC, et al. Salvage cryotherapy for recurrent prostate cancer after radiation therapy: the Columbia experience. Urology 2000; 55:79.
  36. Wieder J, Schmidt JD, Casola G, et al. Transrectal ultrasound-guided transperineal cryoablation in the treatment of prostate carcinoma: preliminary results. J Urol 1995; 154:435.
  37. Thompson I, Thrasher JB, Aus G, et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177:2106.
  38. National Comprehensive Cancer Network (NCCN) guidelines. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on September 14, 2011).
  39. Babaian RJ, Donnelly B, Bahn D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol 2008; 180:1993.
  40. Aus G. Cryosurgery for prostate cancer. J Urol 2008; 180:1882.
  41. Lukka H, Waldron T, Chin J, et al. High-intensity focused ultrasound for prostate cancer: a systematic review. Clin Oncol (R Coll Radiol) 2011; 23:117.
  42. Warmuth M, Johansson T, Mad P. Systematic review of the efficacy and safety of high-intensity focussed ultrasound for the primary and salvage treatment of prostate cancer. Eur Urol 2010; 58:803.
  43. NCCN guidelines http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf (Accessed on December 16, 2013).
  44. Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011; 59:61.
  45. Crouzet S, Chapelon JY, Rouvière O, et al. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol 2014; 65:907.
  46. Roach M 3rd, Hanks G, Thames H Jr, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65:965.
  47. Eastham JA. Editorial comment on: first analysis of the long-term results with transrectal HIFU in patients with localized prostate cancer. Eur Urol 2008; 53:1202.
  48. Netsch C, Bach T, Gross E, Gross AJ. Rectourethral fistula after high-intensity focused ultrasound therapy for prostate cancer and its surgical management. Urology 2011; 77:999.
  49. Golan R, Bernstein AN, McClure TD, et al. Partial Gland Treatment of Prostate Cancer Using High-Intensity Focused Ultrasound in the Primary and Salvage Settings: A Systematic Review. J Urol 2017; 198:1000.
  50. Azzouzi AR, Vincendeau S, Barret E, et al. Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer (CLIN1001 PCM 301): an open-label, phase 3, randomised controlled trial. Lancet Oncol 2016.