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Cryosurgery

by Jeffrey I. Katz, M.D.

Cryosurgery, or the freezing of tissue in order to destroy cancerous or other cells, was first developed in the 1960s as a method to eradicate prostate tissue without radical surgery. Although effective in killing cancer cells, the inability to control the amount of tissue frozen prevented widespread use of the technology.

In the late 1980s, progress in ultrasound imaging led to a renewed interest in cryosurgery. Utilizing ultrasound guidance, the cryoprobe can be guided to the targeted tissue in the same fashion that brachytherapy is administered. The physician activates the cryoprobe and uses ultrasound to monitor the growth of ice in the prostate as it is occurring. When the entire gland is frozen, the probe(s) is turned off and the gland is thawed. Two freeze/thaw cycles are employed.

Recently published ten-year data suggest that cryosurgical ablation of the prostate can deliver disease-free rates comparable to radical surgery and radiation, but with the benefit of lower rates of incontinence, shorter recovery period, and fewer complications.

Technological advances over the years have improved the procedure considerably. Argon replaced liquid nitrogen in 1996,and thermocouplers were introduced in 1997 to monitor the temperature of the freeze ball and surrounding tissues. Improved software, introduction of the cryogrid for the probes, and the computer generated autofreeze process all greatly improved patient outcomes. The use of the urethral warmer also eliminated most urethral complications.

Advantages of cryosurgery are as follows:

1. Effective for a broad range of low- to high-risk prostate cancer patients.
a. In low-risk patients, the success of cryosurgery is
comparable to radiation therapy and radical surgery.
b. In medium- to high-risk cases, the results of
cryosurgery are at least equivalent and appear to be
superior to radiation therapy and radical surgery.
2. Quick recovery time.
a. The procedure offers patients the shortest recovery
period of any definitive prostate cancer therapy and may
result in a lower incident of complications.
3. It can be used in the treatment of patients who have failed radiation therapy.
a. Radiation therapy cannot be repeated once given, but
cryosurgery can be curative in radiation failures.
b. Cryosurgery also has less side effects than salvage-
radical prostatectomy.
4. The treatment can be repeated many times, unlike radiation therapy.

Cryosurgery can also be used to treat kidney tumors, liver lesions, and bone metastases. The improved technology makes it a valuable treatment modality for prostate cancer.

Drs. Katz, Lefkon, and Galdeiri offer cryosurgery of the prostate.

Dr. Savatta offers laparoscopic renal cryosurgery.

Physician Spotlight
Dr. Jeffrey Katz is fellowship trained in urologic oncology from Memorial Sloan Kettering and one of the leaders for prostate cryosurgery for denovo prostate cancer and radiation failures