Cryosurgery of the prostate: techniques and indications.

Cryosurgical ablation of the prostate (CSAP) is indicated for patients with high-stage and high-grade tumors, patients with recurrent/persistent carcinoma of the prostate after external radiation therapy or brachytherapy, and others. At Allegheny General Hospital, CSAP is performed as follows: the patient is prepped in an exaggerated lithotomy position; a volumetric study of the gland is obtained with transrectal ultrasound; 5 to 15 cryoneedles are placed (in three to five horizontal rows) through a 17-gauge, stepper-mounted template; a cystoscopy is performed; and a urethral warming catheter is introduced. The rows of cryoneedles are then activated from anterior to posterior, and generally two freeze-thaw cycles are used. In longer glands, a pullback of the cryoneedles might be needed to completely cover the apical portion of the gland. The skills required for CSAP are identical to those required for brachytherapy needle placement, thus the training required for physicians already proficient in brachytherapy is minimized.