AUA best practice statement recommends cryosurgery in certain cases of prostate cancer

Men with clinically organ-confined prostate cancer of any grade with a negative metastatic evaluation can receive primary cryosurgery, according to a best practice statement issued by the American Urological Association.

When the American Urological Association issued the Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update last year, insufficient data were available on the use of cryosurgery in men with the disease, according to a press release. Since then, a panel of experts convened to develop a best practice statement regarding cryosurgery as a primary treatment option.

Using medical databases, the panel reviewed available data and composed recommendations for treatment with cryosurgery. Included in the recommendations are procedure requirements for maximum efficacy in the following areas:

tissue freeze rate: the panel recommended rapid freezing;
temperature monitoring: the use of thermocouples was strongly advised;
nadir temperature: –40 degrees Celsius is the lowest temperature at which active cells can survive;
thaw rate: cancer is proven to be improved with slow thawing; and
freeze cycles: the panel recommended using a double-freeze thaw cycle.

Though the panel supports the use of primary cryosurgery in certain cases, they wrote that patients at high risk may require multimodal therapy. The use of cryosurgery in clinical T3 disease is undetermined because of limited data on the outcomes of primary cryosurgery in these patients.

According to the statement, when selecting patients eligible for cryosurgery, gland volume, lymph node dissection and comorbidities should be considered.

Despite the lack of a universally accepted biochemical definition of failure, post-treatment PSA levels are an essential part of follow-up, according to the panel. Due to the protection of the urethra during cryosurgery, the panel recognized the unlikelihood of achieving a completely undetectable PSA level following surgery. The panel also recommended that follow-up biopsies be performed.

During data analysis, the panel found documentation of long-term complications that included fistula formation, incontinence, erectile dysfunction and urethral sloughing.

A lack of clinical experience and information on long-term outcomes led the panel to label the use of subtotal prostate cryosurgery as undetermined. They recommended further data be collected and entered into a database for future analysis.

J Urol. 2008;180:1993-2004.