02-10-2004, 09:00 AM
Hey Steph, or anyone else, what do you think of the prospect of prostate cryoblation for prostate cancer vs. radioactive seeds or external beam XRT? I just had a patient during my ER rotation during my TY year that is having some urinary retention after a prostate cryoablation procedure. Thanks.
02-10-2004, 01:27 PM
Cryoablation has more side effects than brachy or external beam. It is an experimental procedure reserved for those who fail brachy.
02-10-2004, 06:02 PM
I've seen a hospital where cryosurgery used quite often as primary therapy for early stage CaP in poor surgical candidates (yes, in lieu of seeds or external beam). It's been around for awhile, but before urethral warming catheters and gas driven cryoprobes, the complication rates were too high and so it was used mainly for salvage. Some urologists (even in private practice) are gaining confidence with it, and it looks alot like PSI with a brachytherapy plate, TRUS guidance, and needles in the perineum. I looked at the literature once for a presentation and some authors claim to have found something as good as radiotherapy. Five-year biochemical recurrence rates are similar. I agree with Niraj, though, complication rates still seem higher and there is a close to 100% chance of impotence. Of course there's not a whole lot of long term data yet.
Urinary retention is a big complication b/c of edema and obstruction by sloughed necrotic urethra (ouch!). Long term perineal pain and edema is possible too. They use thermometer probes to monitor how cold the rectum is getting so they get fewer bowel/rectal symptoms than PSI or external beam.
There's controversy but, assuming the longer-term data is favorable, it may become more widely accepted, especially for patients who already have ED. If you want the references I found, send a message to me and I'd be happy to pass them along. There's even one about EBRT as salvage for failure post-cryo.