American Urological Association releases best practice statement on cryosurgery

When the American Urological Association (AUA) guideline on the Management of Clinically Localized Prostate Cancer: 2007 Update was published, insufficient information was available to include cryosurgery in the data analysis. Therefore, the AUA convened a panel of experts to develop the next level of evidence, a best practice statement, regarding the treatment of localized prostate cancer using cryosurgery. The panel reached a consensus that primary cryosurgery is an option for men who have clinically organ confined prostate cancer of any grade with negative metastatic evaluation. Clinicians using cryosurgery are advised to review this best practice statement, which is published in the November 2008 issue of The Journal of Urology. A Best Practice Statement (BPS) uses published data in concert with expert opinion, but does not employ formal analysis of the literature. The panel, chaired by Richard J. Babaian, MD, Professor of Urology and Director, Prostate Cancer Detection Clinic, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, carefully reviewed findings published in the medical literature from 2000 to 2008, shared their expert opinions and experience treating several thousands of patients and formulated recommendations. These recommendations were achieved through a rigorous consensus process.

Babaian and colleagues note that case selection is a primary factor. Larger prostates may make it more difficult to uniformly achieve cold enough temperatures and previous transurethral resection may be a contraindication. Cryosurgery is a minimally invasive option for men who either do not want to undergo or are not good candidates for radical prostatectomy because of comorbidities such as obesity or history of pelvic surgery. The authors also made recommendations for maximizing the results of cryosurgery, such as using rapid freezing thermocouples to monitor temperature and a double freeze cycle, and obtaining a nadir temperature of -40. Complications are outlined based on the available literature.

In the 1960s and 1970s, cryosurgery was performed with liquid-nitrogen probes. The freezing process was difficult to monitor and this led to many complications. As the technology improved, there has been a significant reduction in overall side effects, including urinary incontinence, rectal pain and urethral sloughing.

Panel Chair Richard J. Babaian and panel members write, "In summary, a review of the historical evolution of cryosurgery provides two overriding messages, the first being that there is evidence of therapeutic benefit, and the second, that treatment-associated morbidity has been reduced as technological refinements have emerged."

Source: Elsevier Health Sciences