CRYOTHERAPY or CRYOSURGERY
How cryosurgery works
There are three clinical applications for prostate cryoablation including:
1. Primary Prostate Cryoablation where in the clinical goal is to totally ablate the entire gland.
2. Salvage Prostate Cryoablation for radio-recurrent disease.
3. Partial Gland Cryoablation wherein the clinical goal is to ablate the known tumour location, thereby, sparing surrounding tissue.
Primary Cryoablation (Total Gland)
Total gland ablation of the prostate is the complete ablation of the prostate and periprostatic tissue with lethal ice at –40°C. It should be noted that Primary Cryoablation may be especially attractive for patients at risk for positive margins since the ice can be advanced beyond the prostate capsule. Additionally, Cryoablation is not limited by Gleason score. Finally, since the procedure can be performed under general or spinal anaesthesia it may be appropriate for patients who are unable to tolerate the risks of general anaesthesia or possible per- and post-operative complications.
The optimal candidates for Primary Cryoablation are patients with:
- Biopsy confirmed local disease
- Low, medium or high-risk primary prostate cancer
- Stage T1 through T3
- Gland <45cc is optimal (larger glands may be amenable to treatment if downsized using androgen ablation).
Salvage Cryoablation is indicated for those patients with localized disease who have failed a course of radiation therapy, either external beam, HDR, brachytherapy or a combination of radiation therapies. In the USA, Medicare has approved coverage for patients who meet one of the following conditions:
- Biopsy confirmed local disease and/or
- StageT2B, or below, and/or
- Gleason Score < 9, and/or
- PSA < 8ng/mL.
Partial Gland Ablation, also known as Focal or Targeted Cryoablation of the Prostate (TCAP)
Cryoablation may be especially suited for use as a nerve sparing or focal therapy. The two clinical approaches are Nerve Sparing TCAP and Focal TCAP. The methodology used depends upon the believed extent of the patient’s disease. Regardless of the approach used, it is important to note that cryoablation has a proven ability to be repeated without increased morbidity unlike radiation or prostatectomy. Because a portion of the prostate is intentionally untreated extensive diagnostic biopsy and vigilant follow-up is essential for any partial gland procedure.
Regarding Kidney Cancer cryotherapy is always intended as Focal treatment