History and Development of Prostate Cryoablation

bDFS (%)

Ref. (with actuarial data)

No. patients

Median follow-up in months (range)

Technique

PSA threshold

Low risk

Intermediate risk

High risk

nADT (%)

Bahn et al. [37] (7-year data)

590

68 (NA)

LN/Ar

<0.5

<1.0

Cohen et al. [39] (10-year data)

204

12.6 (9.7–15.0)

ASTRO

56 (all risk groups)

Han et al. [38] (1-year data)

122

12 (NA)

<0.4

Jones et al. [36]

(5-year data)

1198

24 (SD ± 26)

LN/Ar

ASTRO

Long et al. [35] (5-year data)

975

24 (SD ± 16.5)

LN/Ar

<0.5

<1.0

Modified from Langenhuijsen JF Eur. Urol 2009; 55: 76–86; LN Liquid nitrogen, Ar Argon

Table 17.2

Results of salvage cryosurgery

					bDFS (%)
Ref. (with actuarial data)	No. patients	Median follow-up in months (range)	Technique	PSA threshold	Low risk	Intermediate risk	High risk	nADT (%)
Bahn et al. [43] (7-year data)	59	82 (NA)	Ar	<0.5	59 (all			NA
Chin et al. [40] (5-year data)	118	19 (3–54)	Ar	<0.5	NA	NA	34	60
Ismail et al. [41] (5-year data)	100	33 (mean)(12–79)	Ar	<0.5	73	45	11	46
Ng et al. [42] (8-year data)	187	39 (mean) (NA)	Ar	Houston	56	NA	14	71
Pisters et al. [14] (5-year data)	279	22 (SD ± 25)	LN/Ar	ASTRO Phoenix	59 (all risk groups) 55 (all risk groups)			NA

Modified from Langenjuijsen JF Eur. Urol 2009; 55: 76–86; LN Liquid nitrogen, Ar Argon, bDFS Biochemical disease-free survival

The major complications that were frequently reported in the early periods of cryosurgery for prostate cancer in the 1960s through the 1980s have been significantly reduced in both the primary and salvage settings. The contemporary reports for primary cryoablation reveal complication rates of <0.5% for rectal fistula formation [44], <8% for permanent urinary incontinence [45] and <15% for urethral sloughing when a urethral warming device is employed [46]. Erectile dysfunction remains a significant problem in patients undergoing total gland ablation in men in which the ice ball is allowed to extend to both neurovascular bundles. One year and four year potency rates of 41.4 and 51.3% have been reported with penile rehabilitation [47]. In the salvage setting complications are higher with incontinence reported in approximately 10%, urethral sloughing in 10%, rectal pain in 17% and rectal fistula in 3%. Tables 17.3 and 17.4, show the reported complications in selected series of patients undergoing primary and salvage therapy, respectively [14, 31, 35–42, 48–50].

Table 17.3

Complications (%) after primary cryosurgery

Ref.	No. patients	Technique	Fistula	Retention	Incontinence	Impotence	Perineal pain
Badalament et al. [49]	290	Cryocare	0.4	NA	4.3	85	12
Bahn et al. [37]	590	LN/Ar	0.004	5.5	4.3	95	NA
Cohen et al. [39]	239	Cryocare Seednet	2.2	3	0.4	4	0.4
Han et al. [38]	122	AR	0	NA	3	87	6
Jones et al. [36]	1198	LN/Ar	0.4	NA	2.9	91	NA
Long et al. [35]	975	LN/Ar	0.4	10	7.5	93	NA
Shinohara et al. [31]	102	NA	1	23	15	86	3
Wake et al. [48]	106	Cryocare	0	22	8	NA	NA

Table 17.4

Complications (%) afte r salvage cryosurgery

Ref.	No. patients	Technique	Fistula	Retention	Incontience	Impotence	Perineal pain
Chin et al. [40]	118	Ar	3.3	8.5	6.7	NA	NA
Ismail et al. [41]	100	Ar	1	2	13	86	4
Katz et al.[50]	157	Cryocare seednet	0	5.8/1.9	9.7	NA	12.8
Ng et al. [42]	187	Ar	2	21	3	NA	14
Pisters et al. [14]	279	LN/Ar	1.2	NA	4.4	NA	NA