Objective: To determine the clinical outcome after transrectal
ultrasound (TRUS) guided cryosurgical ablation of the prostate (CSAP)
for stages T1-T4 cancer.
Methods and Materials: Serum PSA and biopsy data were reviewed in 485 patients who received CSAP for localized prostate cancer. 75% of the patients had early cancer (T1-T2), and 25% had locally advanced cancer (T3-T4). Mean age was 68. Mean follow-up was 20 months (6-36). Cryoprobes were placed transperineally and temperature monitoring devices were used to objectify the feezing processes.
Results: Postoperative follow-up biopsy showed 13.5% failure rate. For stages T1-T2 and T3-T4, it was 9% and 25%, respectively. For those with negative biopsies, 84% had PSA level of less than 0.5 ng/ml. Major complications of rectal fistula, incontinence, and outlet obstruction were 0.25%, 4%, and 9%, respectively. Impotence occurred in 85% of patients who were potent preoperatively.
Conclusion: Results of biopsy and PSA after CSAP for stages T1-T4 prostate cancer are encouraging. This procedure is highly operator dependent. It requires a unique combination of TRUS and intervetional radiological skill.