October 1997
Pedram Derakhshani, Juergen Zumbè, Axel Heidenreich, Stephan Neubauer, Udo Engelmann.
Department of Urology, University of Cologne, Germany.

INTRODUCTION & OBJECTIVES: Since 1991 cryoablation of the prostate has been available as a minimal-invasive therapeutic alternative in the treatment of organ-confined prostate cancer. Improvements in cryotechnique and progress in transrectal high-resolution ultrasound permit thermoinduced destruction of the whole gland or desired target areas.


MATERIAL & METHODS: We present our experience with this innovative technique in a series of 48 patients and report on the results of the control-biopsies and the complications. The patients are staged completely including laparoscopic lymphadenectomy in patients with an initial PSA of greater than 10 ng per ml. The cryosurgical double-freeze procedure is performed with thermo-couple control under permanent high-resolution transrectal ultrasound monitoring utilising an urethral warming catheter.


RESULTS: We treated 7 patients staged T1, 21 with a T2 disease and 20 patients with a T3 tumor. 62.5% received a neoadjuvant hormonal downsizing. Positive control-biopsies were obtained in 0% (0/7) of T1 tumors, 17% (3/18) of T2 tumors and 27% (4/15) of T3 tumors. PSA-progression was diagnosed in 0% (0/7), 17% (3/18), and 27% (4/15) of the cryotreated patients.

Erectile dysfunction was noticed by 81% of patients in the initial postoperative period. 6 months postooperatively 69% of patients remained partially or completely impotent. Complications included prolonged urinary retention in 23%, requiring a TUR in 5 patients to relieve obstruction. Scrotal hematoma developed in 17% of patients, but resolved spontaneously in all cases. Incontinence was noticed in 5 patients (10%), 2 of those patients being pre-treated with radiotherapy. A perineal abscess requiring drainage was found in 1 patient.


CONCLUSIONS: Cryoablation of the prostate is not a substitution for radical prostatectomy but enables the surgeon to perform refusing an open operation. Long-term follow-up and prospective studies will define the future significance of this procedure.

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