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Cryosurgery for Prostate Cancer

Riverside Urology has been involved in the application of cryosurgery for the treatment of prostate cancer since 1994.  Dr. Riemenschneider in conjunction with Dr. Wodarcyk at Park Medical Center have applied cryosurgical treatment to patients with cancer of the prostate in two general categories.  The first category being primary when cryoablation  is used to treat cancer when it is diagnosed and confined to the prostate gland.  Cryoablation is also used as salvage therapy when prostate cancer has recurred after another primary treatment, usually radiation therapy.

Dr. Riemenschneider and Dr. Alfred Granson reviewed the Ohio experience with cryosurgery for prostate cancer and followed 101 cases over thirty months.  The outcome for primary application of cryosurgery to prostate cancer with an 80% success rate determined via negative biopsy and PSA levels, their findings are comparable to other nationally reported series.  The salvage application of cryosurgery for patients who failed prior radiation therapy for treatment of prostatic cancer was also successful when it is understood that there is no other successful salvage therapy.  The success rate in this application was 50%.  Some other nationally reported series reported slightly higher success rates.

Cryoprobes as they freeze the prostate

The history of cryosurgery is quite interesting.  The principle of cryogenics was born in 1877 when two papers were delivered before the French Academy of Sciences by Gillet, a French scientist and Pictet, a Swiss engineer describing liquefaction of oxygen.  The modern age of cryosurgery began in 1961 when Dr. Irvin S. Cooper developed the first closed cryoprobe which circulated cold nitrogen gas.  Cryoprostatectomy became fashionable for a short time in the early 1970s.  However, because of the inability to monitor cryosurgery and the lack of sophisticated instrumentation its application for the destruction of diseased prostate tissue was delayed.  During the late 1980s real time ultrasound imaging techniques gained prominence in the surgical suite and provided new and easier ways to image the prostate during application of cryosurgery.  Doctors at the Allegheny general hospital in Pittsburgh developed procedures using cryosurgery and it was used initially to freeze liver tumors.  Dr. Onik and Dr. Jeffrey Cohen employed the use of transrectal ultrasound to effectively monitor the freezing process of the prostate.   The scientific experimentation of modern pericutaneous cryosurgical technique was concluded in 1990, and human investigations were completed in 1992.

There are three distinct groups of patients that can benefit from cryosurgery.  One, patients who failed radiation therapy and whose PSA levels and biopsy data indicated recurrence of prostate carcinoma that is confined to the prostate.  Two, patients with the disease that has extended beyond the capsule of the prostate but is still localized within the region of the prostate.  These patients are poor candidates for radical prostatectomy but can be successfully treated with cryoablated techniques.  Three, patients with early stage carcinoma of the prostate who have not had previous treatment.  These patients are typically candidates for radical prostatectomy or radiation therapy but prefer alternative treatment such as cryoablation because of less morbidity and less complicated recovery.

The procedure is less expensive than traditional prostatectomy.  It requires a shorter length of stay and no blood transfusion.  The average patient is discharged within 24 hours of admission.

We now have the technology that has the proven ability to destroy prostate cancer and does not require incisional surgery, only a pericutaneous skin puncture to deliver the cryotherapy.  The application of cryosurgery to early carcinoma of the prostate confined to the prostate gland is not yet universally accepted by the urology community, but data accumulated of the last five years has convinced many skeptics.  As of August 12, 1996 the AUA issued a statement that cryoablation therapy for prostate cancer should be considered along with all other treatments, but that its long term efficacy has not yet been proven.