[Cryotherapy III, bibliographic review. Our experience(II)].

OBJECTIVES: To perform a bibliographic review of the main features of cryotherapy as a therapeutic option in the monagemente of prostate cancer and to report our initial experience.

METHODS: We employed the Endocare Fast-Trac system (Medipro) with 2.4 mm needles implanted in a single maneouvre without rack or transrectal U.S. transducer support. Two cycles of freezing thawing were employed, with apex backward movement when necessary. Freezing cycle duration was between 7-10 minutes or more. The Onik maneouvre--injection of saline into the Denonvillier's space-diminishes the risk of rectal injury and fistula allowing reaching posterior limits of the icaball beyond the prostatic capsule.

RESULTS: We treated 20 patients. Follow-up was between 3036 months. 58% of the patients had unilateral prostate cancer, 42% bilateral. In accordance to the classic definition 9 patients were classified as low risk of extraprostatic disease, 6 medium risk and 5 high risk; using number of positive cores as the criterion for risk 5, 6 and 9 were low, medium and high risk respectively. Per protocol prostate biopsies were performed in 18 patients 6, 12 and 24 months after treatment. Two patients underwent a second treatment due to persistence of cancer cells in the 6-month biopsy (11%). 3-month PSA nadirs after a total of 21 cryo treatments administered were < 0,2 ng/cc in 15 cases (78.9%), < 0.5 ng/cc in 17 (89.4%) and < or = 1.0 ng/cc in 18 (94.7%); it was over 1 ng/cc in only 5.6%. 30 month PSA for the same cutoff values was 27.8%, 50.0%, 66.6% and 33.3%, respectively. Prostate cancer cells were detected in the 12-month biopsies of 5.5% cases. All 24-month biopsies were negative.

COMPLICATIONS: We observed scrotal edema, hematoma, perineal pain and constipation which lasted 2-3 weeks. 1 patient suffered injury of the mucosa at the prostatic urethra, which did not result in rectal fistula and was treated with bladder catheter for 3 months. 4 patients had erectile dysfunction before treatment. All others presented erectile dysfunction after treatment; 3 of them (20%) recovered rigidity enough to have intercourse over the 30 month period. No urethral sloughing or acute urinary retention appeared and all patients are continent.

CONCLUSIONS: Prostatic cryosurgery is an effective, minimally invasive procedure for the treatment of prostate cancer with very low surgical risk, low morbidity and almost null mortality.