Prostate cancer cryotherapy

Zhernov A.A., Keshishev N.G., Shaderkin I.A., Koryakin A.V.

Recently minimally invasive methods of prostate cancer treatment has been widely distributed, they were developed to minimize surgical intervention using organ-preserving technique but without oncologic compromise: brachytherapy, HIFU therapy, radiofrequency ablation and cryoablation. An ultralow temperature is already used in the treatment of oncological diseases more than 150 years, at the period great technological advance occurs. Latest generation cryogenic devices operate from pressurized argon and probe thickness is not to exceed the same of biopsy needle. Cryoablation action is based on body of biological reactions including necrosis, inflammation, immune system activation. The method is used both for primary cancer treatment and for saving purpose. The method application results are quite encouraging: 5-year disease free survival for primary patients is from 60% to 90% depending on degree of risk; in patients with relapse after other treatment modalities the survival value is 40-70%. Most common complication of the procedure is erectile dysfunction, which occurs in 92% operated patients. Other general complications are urine retention (3,6%) and incontinence (4,8%). Due to permanent progress in technical maintenance of cryosurgery procedures a complication rate decreased significantly as compared with early results, however in view of high risk of erectile dysfunction the method is suitable rather in elderly patients. While being relatively new method of prostate cancer treatment cryoablation show its effectiveness with good specific survival outcomes and biochemical disease control. Effectiveness greatly depends on proper patient selection together with strict adherence to procedure technique at all steps and dynamic temperature control at the operation area and adjacent tissues.