Abstract
Focal therapy for prostate cancer has emerged an interesting concept as a less morbid option for the treatment of localized low-risk disease. Despite the growing interest in focal therapy, this approach has not yet gained sufficient popularity nor provided enough data to be discussed outside the experimental application. Herein we summarize the available data on focal cryotherapy and focus on the targets to be achieved in order to increase the applicability of focal cryotherapy to clinical practice. A cautious approach to candidate selection and generation of solid scientific data that would result in wide consensus on patient selection strategies and follow-up schemes would provide the tools necessary to take the path of focal therapy. Currently available focal cryotherapy data demonstrate excellent short-term results and a favorable quality-of-life profile. Although the future role of focal treatment is debated, a growing amount of science is generated in support of this minimally invasive approach.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Polascik TJ, Mouraviev V: Focal therapy for prostate cancer is a reasonable treatment option in properly selected patients. Urology 2009, 74:726–730.
• Mouraviev V, Mayes JM, Sun L, et al.: Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer. Cancer 2007, 110:906–910. Approximately one in five men with prostate cancer has unilateral disease, potentially amenable to focal therapy.
Jordan WP Jr, Walker D, Miller GH Jr, et al.: Cryotherapy of benign and neoplastic tumors of the prostate. Surg Gynecol Obstet 1967, 125:1265–1268.
Polascik TJ, Mouraviev V: The rise of ablative technologies for treating the small renal mass. Eur Urol 2007, 52:636–638.
Babaian RJ, Donnely B, Bahn D, et al.: Best policy statement on cryosurgery for the treatment of localized prostate cancer. American Urological Association 2008. Available at http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm.
Onik G, Vaughan D, Lotenfoe R, et al.: “Male lumpectomy”: focal therapy for prostate cancer using cryoablation. Urology 2007, 70:16–21.
Onik G, Vaughan D, Lotenfoe R, et al.: The “male lumpectomy”: focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol 2008, 26:500–505.
Bahn DK, Silverman P, Lee F Sr, et al.: Focal prostate cryoablation: initial results show cancer control and potency preservation. J Endourol 2006, 20:688–692.
Lambert EH, Bolte K, Masson P, et al.: Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology 2007, 69:1117–1120.
Ellis DS, Manny TB Jr, Rewcastle JC: Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results. Urology 2007, 70:9–15.
Mayes JM, Mouraviev V, Sun L, et al.: Can the conventional sextant prostate biopsy accurately predict unilateral prostate cancer in low-risk, localized, prostate cancer? Urol Oncol 2009 May 16 (Epub ahead of print).
Tsivian M, Kimura M, Sun L, et al.: Predicting unilateral prostate cancer on routine diagnostic biopsy: sextant vs extended. BJU Int 2009 Oct 10 (Epub ahead of print).
Polascik TJ, Mayes JM, Schroeck FR, et al.: Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy. Cancer 2009, 115:2104–2110.
Onik G, Barzell W: Transperineal 3D mapping biopsy of the prostate: an essential tool in selecting patients for focal prostate cancer therapy. Urol Oncol 2008, 26:506–510.
Pinkstaff DM, Igel TC, Petrou SP, et al.: Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology 2005, 65:735–739.
Medline PubMed: http://www.ncbi.nlm.nih.gov/pubmed/. Accessed November 2009.
Black P: There is no role for focal therapy in prostate cancer. Can Urol Assoc J 2009, 3:331–332.
Lindner U, Trachtenberg J: Focal therapy for localized prostate cancer: choosing the middle ground. Can Urol Assoc J 2009, 3:333–335.
Lindner U, Weersink RA, Haider MA, et al.: Image guided photothermal focal therapy for localized prostate cancer: phase I trial. J Urol 2009, 182:1371–1377.
Eggener SE, Scardino PT, Carroll PR, et al.: Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 2007, 178:2260–2267.
• Ahmed HU, Moore C, Emberton M: Minimally-invasive technologies in uro-oncology: the role of cryotherapy, HIFU and photodynamic therapy in whole gland and focal therapy of localised prostate cancer. Surg Oncol 2009, 18:219–232. This article features a comprehensive overview of ablative technologies in prostate cancer treatment.
Disclosure
Dr. Thomas J. Polascik has received research support from Galil Medical. No other potential conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsivian, M., Polascik, T.J. Focal Cryotherapy for Prostate Cancer. Curr Urol Rep 11, 147–151 (2010). https://doi.org/10.1007/s11934-010-0100-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11934-010-0100-1