Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results.

The study reported here was undertaken to assess medium short-term efficacy of focal cryoablation as primary therapy for localized prostate cancer and to determine the rate of morbidity in patients who undergo this treatment. Patients were treated with focal cryoablation with argon cryoprobes under ultrasonographic visualization with temperature monitoring. Men who were potent at the time of intervention were encouraged to use a vacuum erectile dysfunction device on a regular basis after treatment. Incontinence was defined as any urine leakage regardless of the number of pads worn (if any). Potency was defined as the ability to achieve an erection sufficient to complete intercourse with or without oral pharmaceuticals. Biochemical failure was defined as 3 successive rises in serum prostate-specific antigen (PSA) concentration. A total of 60 consecutive patients were treated. Mean patient age was 69.0 years; mean PSA was 7.2 ng/mL, median Gleason score was 6, and median stage was T1c. Before treatment was initiated, all patients were continent and 72.7% were potent. Mean follow-up for the entire population was 15.2+/-7.4 months. Of those patients who were continent before receiving treatment, 3.6% were incontinent at 6 months, but none used any absorbent pads. At last follow-up, 80.4% of patients were biochemically disease free; mean time to failure was 3.5 months among those for whom treatment failed. The positive biopsy rate after first treatment was 23.3%, and mean time to failure was 12.0 months. Of those who underwent a second focal cryoablation procedure after positive biopsy, 66% were subsequently cancer free. All patients who were potent after the first cryoablation procedure regained their potency after the second cryoablation procedure. Focal cryoablation combined with penile rehabilitation as primary treatment for localized prostate cancer is a minimally morbid procedure with acceptable morbidity and the potential for retreatment of a patient if cancer is subsequently detected. Further study is warranted.