European Radiology

, Volume 22, Issue 8, pp 1829–1835 | Cite as

Percutaneous MR-guided cryoablation of prostate cancer: initial experience

  • Afshin GangiEmail author
  • Georgia Tsoumakidou
  • Omar Abdelli
  • Xavier Buy
  • Michel de Mathelin
  • Didier Jacqmin
  • Hervé Lang



We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance.


Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI.


Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1–25). Mean PSA nadir was 0.33 ng/ml (range: 0.02–0.94 ng/ml). Mean hospitalisation was 5 days (range: 3–13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain.


MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy.

Key Points

Magnetic resonance allows precise positioning of cryoprobes with real-time imaging.

High-resolution MRI allows excellent monitoring of the developing ice ball.

Cryoablation of prostate cancer under MR guidance is technically feasible.

Further work will refine the procedure and make it even safer.


Prostate cancer Percutaneous thermal ablation MR guidance Cryoablation Rectal thermal protection 


  1. 1.
    Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–592PubMedCrossRefGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300PubMedCrossRefGoogle Scholar
  3. 3.
    Ataman F, Zurlo A, Artignan X et al (2004) Late toxicity following conventional radiotherapy for prostate cancer: analysis of the EORTC trial 22863. Eur J Cancer 40:1674–1681PubMedCrossRefGoogle Scholar
  4. 4.
    Potosky AL, Legler J, Albertsen PC et al (2000) Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcome Study. J Natl Cancer Inst 92:1582–1592PubMedCrossRefGoogle Scholar
  5. 5.
    Heidenreich A, Bolla M, Joniau S et al (2011) Guidelines on Prostate Cancer. European Association of Urology.
  6. 6.
    Gonder MJ, Soanes WA, Shulman S (1966) Cryosurgical treatment of the prostate. Invest Urol 3:372–378PubMedGoogle Scholar
  7. 7.
    Ghafar MA, Johnson CW, De La Taille A et al (2001) Salvage cryotherapy using an argon based system for locally recurrent prostate cancer after radiation therapy: the Columbia experience. J Urol 166:1333–1337, discussion 1337–1338PubMedCrossRefGoogle Scholar
  8. 8.
    Onik GM, Cohen JK, Reyes GD, Rubinsky B, Chang Z, Baust J (1993) Transrectal ultrasound-guided percutaneous radical cryosurgical ablation of the prostate. Cancer 72:1291–1299PubMedCrossRefGoogle Scholar
  9. 9.
    Onik G (2007) Percutaneous image-guided prostate cancer treatment: cryoablation as a successful example. Tech Vasc Interv Radiol 10:149–158PubMedCrossRefGoogle Scholar
  10. 10.
    Cohen JK, Miller RJ, Shuman BA (1995) Urethral warming catheter for use during cryoablation of the prostate. Urology 45:861–864PubMedCrossRefGoogle Scholar
  11. 11.
    Zisman A, Pantuck AJ, Cohen JK, Belldegrun AS (2001) Prostate cryoablation using direct transperineal placement of ultrathin probes through a 17-gauge brachytherapy template-technique and preliminary results. Urology 58:988–993PubMedCrossRefGoogle Scholar
  12. 12.
    Pisters LL, von Eschenbach AC, Scott SM et al (1997) The efficacy and complications of salvage cryotherapy of the prostate. J Urol 157:921–925PubMedCrossRefGoogle Scholar
  13. 13.
    Long JP, Bahn D, Lee F, Shinohara K, Chinn DO, Macaluso JN Jr (2001) Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology 57:518–523PubMedCrossRefGoogle Scholar
  14. 14.
    Donnelly BJ, Saliken JC, Ernst DS et al (2002) Prospective trial of cryosurgical ablation of the prostate: five-year results. Urology 60:645–649PubMedCrossRefGoogle Scholar
  15. 15.
    Han KR, Cohen JK, Miller RJ et al (2003) Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol 170:1126–1130PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen JK, Miller RJ Jr, Ahmed S, Lotz MJ, Baust J (2008) Ten-year biochemical disease control for patients with prostate cancer treated with cryosurgery as primary therapy. Urology 71:515–518PubMedCrossRefGoogle Scholar
  17. 17.
    Leibovici D, Zisman A, Siegel YI, Lindner A (2001) Cryosurgical ablation for prostate cancer: preliminary results of a new advanced tecnhique. IMAJ 3:484–487PubMedGoogle Scholar
  18. 18.
    Polascik TJ, Nosnik I, Mayes JM, Mouraviev V (2007) Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third-generation cryotechnology. Urology 70:117–121PubMedCrossRefGoogle Scholar
  19. 19.
    Mazaheri Y, Shukla-Dave A, Hricak H et al (2008) Prostate cancer: identification with combined diffusion-weighted MR imaging and 3-D 1H spectroscopic imaging—correlation with pathologic findings. Radiology 246:480–488PubMedCrossRefGoogle Scholar
  20. 20.
    Claus FG, Hricak H, Hattery RR (2004) Pretreatment evaluation of prostate cancer: role of MR imaging and 1H MR spectroscopy. Radiographics 24:S167PubMedCrossRefGoogle Scholar
  21. 21.
    Franiel T, Hamm B, Hricak H (2011) Dynamic contrast-enhanced magnetic resonance imaging and pharmacokinetic models in prostate cancer. Eur Radiol 21:616–626PubMedCrossRefGoogle Scholar
  22. 22.
    Heijmink SW, Futterer JJ, Strum SS et al (2011) State-of-the-art uroradiologic imaging in the diagnosis of prostate cancer. Acta Oncol 50:25–38PubMedCrossRefGoogle Scholar
  23. 23.
    Silverman SG, Tuncali K, vanSonnenberg E et al (2005) Renal tumors: MR imaging-guided percutaneous cryotherapy—initial experience in 23 patients. Radiology 236:716–724PubMedCrossRefGoogle Scholar
  24. 24.
    Chen X, Barkauskas KJ, Nour SG, Duerk JL, Abdul-Karim FW, Saidel GM (2007) Magnetic resonance imaging and model prediction for thermal ablation of tissue. J Magn Reson Imaging 26:123–132PubMedCrossRefGoogle Scholar
  25. 25.
    Theodorescu D (2004) Cancer cryotherapy: evolution and biology. Rev Urol 6:S9–S19PubMedGoogle Scholar
  26. 26.
    Saliken JC, Donnelly BJ, Rewcastle JC (2002) The evolution and state of modern technology foe prostate cryosurgery. Urology 60:26–33PubMedCrossRefGoogle Scholar
  27. 27.
    Lu A, Daniel BL, Kaye E, Butts-Pauly K (2011) MRI of frozen tissue demonstrates a phase shift. Magn Reson Med 66:1582–1589PubMedCrossRefGoogle Scholar
  28. 28.
    Chin JL, Pautler SE, Mouraviev V, Touma N, Moore K, Downey DB (2001) Results of salvage cryoablation of the prostate after radiation: identifying predictors of treatment failure and complications. J Urol 165:1937–1941, discussion 1941–1932PubMedCrossRefGoogle Scholar
  29. 29.
    Donnelly BJ, Saliken JC, Ernst DS et al (2005) Role of transrectal ultrasound guided salvage cryosurgery for recurrent prostate carcinoma after radiotherapy. Prostate Cancer Prostatic Dis 8:235–242PubMedCrossRefGoogle Scholar
  30. 30.
    Han KR, Belldegrun AS (2004) Third-generation cryosurgery for primary and recurrent prostate cancer. BJU Int 93:14–18PubMedCrossRefGoogle Scholar
  31. 31.
    Ahmed HU, Freeman A, Kirkham A et al (2011) Focal therapy for localized prostate cancer: a phase I/II trial. J Urol 185:1246–1254PubMedCrossRefGoogle Scholar
  32. 32.
    Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J (2008) The "male lumpectomy": focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol 26:500–505PubMedCrossRefGoogle Scholar
  33. 33.
    de la Rosette J, Ahmed H, Barentsz J et al (2010) Focal therapy in prostate cancer—report from a consensus panel. J Endourol 24:775–780PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Afshin Gangi
    • 1
    Email author
  • Georgia Tsoumakidou
    • 1
  • Omar Abdelli
    • 1
  • Xavier Buy
    • 1
  • Michel de Mathelin
    • 2
  • Didier Jacqmin
    • 3
  • Hervé Lang
    • 3
  1. 1.Department of Interventional RadiologyUniversity Hospital of StrasbourgStrasbourgFrance
  2. 2.LsiitUniversity of StrasbourgStrasbourgFrance
  3. 3.Department of UrologyUniversity Hospital of StrasbourgStrasbourgFrance

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