Modern cryosurgery effective treatment for renal and prostatic tumors

Minimally invasive cryosurgery appears to be an effective treatment for organ-confined prostate cancer and small renal masses, according to two reports in the Journal of Urology for October.

Improvements in “third generation” cryosurgery for prostate cancer include transrectal ultrasound guidance, urethral warmers and gas-driven probes, Dr. Arie S. Belldegrun, of the University of California Los Angeles note. Because 17-gauge needles are used, neither serial dilation nor tract formation is required to place the probes. They treated 106 patients at eight institutions with percutaneous cryosurgery using a brachytherapy template and 12 to 15 cryoneedles to outline the shape of the prostate in each patient.At 12-month follow-up, PSA measurements revealed that 75% of patients were free of biochemical recurrence. About 87% of patients became impotent. Otherwise, complication rates were low. No urethrorectal fistulas or strictures were detected.”Third generation cryosurgery should not only be considered in older or high-risk medical patients who would not otherwise be considered for radical prostatectomy, but also in patients who present after failure of radiation therapy,” Dr. Belldegrun’s group advises.They also suggest that salvage cryotherapy may replace salvage prostatectomy, hormone deprivation or watchful waiting after failure of radiation therapy.In the second report, Dr. Robert B. Nadler and colleagues at Northwestern University Medical School, Chicago, advocate use of laparoscopic renal cryosurgery for renal masses < 3 cm in diameter, based on their experience treating 15 such patients. Length of hospital stay averaged 3.5 days, and patients returned to work after a mean of 16.5 days.Renal function, as determined by creatinine measurements, was maintained following surgery. Only one patient had a mass exceeding 3 mm, and his treatment failure was attributed to incomplete treatment of the periphery of the lesion. One other patient ultimately required nephrectomy because of multifocal papillary renal cell carcinoma.Based on the results of these two studies, Dr. Jeffrey K. Cohen, of Triangle Urological Group in Pittsburgh, notes that minimally invasive approaches that are possible with cryosurgery improve visualization and decrease surgical morbidity. In his editorial, he suggests "the next step" in this procedure is "percutaneous destruction monitored by CT, MRI or positron emission tomography CT scanning."(Source: J Urol 2003;170:1121-1131: Reuters Health: October 7, 2003: Oncolink)