Cryosurgery of the prostate: techniques and pitfalls.

The preliminary data on prostate cryosurgery encompass reports only on local recurrence rates. The procedure is too new to report any survival figures. For localized organ-confined disease, the initial reports at 1 year of positive biopsies following cryosurgery range from 8% to 33%. With clinical stage C disease, a review of the literature also shows a range of 16% to 33% for local recurrence at one year. The largest series of patients treated after failure from radiation therapy is from the M.D. Anderson Cancer Center, which reports a positive biopsy rate of 29% at 6 months. Reports of major complications have included a 2% to 5% incidence of rectourethral fistulas, a 7% to 15% incidence of urinary retention requiring a secondary TURP or prolonged catheter drainage, 2% to 7% incidence of stress incontinence, and a 50% to 80% incidence of impotence. While these overall results may not be optimal to many, they do give us optimism. It is important to recognize that knowledge of the cryosurgical technique is evolving rapidly, and present modifications are not reflected yet in our results. Because hypothermia is a modality proven to cause lethal injury to cancer cells, it would be unfortunate if clinicians dismissed this modality without rigorous review of the surgical technique. The detailed methodology described in this article expedites the learning curve of practicing cryosurgeons and helps to standardize the way cryosurgery is performed.