PROSTATE CRYOABLATION
PATIENT SELECTION

Cryotherapy, also known as Cryosurgery, Cryo, and Cryoablation, can be effective as a primary and/or salvage treatment for prostate cancer. To determine eligibility, patients generally meet certain criterion that are not fixed, but rather vary based on the physician performing the treatment.

Primary prostate cryoablation is a treatment option to men who have clinically organ-confined disease of any grade with a negative metastatic evaluation.

Dr. Tannenbaum discusses appropriate patient selection criteria for primary cryotherapy patients.

Patients who have undergone prostate cancer radiation therapy or another treatment for prostate cancer and have experienced a recurrence are left with limited treatment options. The patient may opt for a salvage radical prostatectomy that may cause significant side effects or hormone therapy that will reduce the size of the tumor but not offer a cure. Salvage prostate cryoablation is a treatment option with curative intent in men who have had a recurrence of their prostate cancer.

Dr. Waterhouse discusses why he recommends salvage cryotherapy to his patients.

a. Primary Prostate Cryoablation

Primary prostate cryoablation is recognized by both the American Urological Association (AUA) and the European Association of Urology (EAU) as a treatment for prostate cancer. A detailed patient selection criteria guideline is available from both associations.

Below are a few of the criteria.

AUA’s recommended guideline on primary prostate cryoablation includes:

  • Clinically organ-confined disease of any grade with a negative metastatic evaluation
  • A PSA level of ≤10
  • Gleason score 7 to <8 with a PSA level >10 to <20 ng/mL and/or clinical stage T2b

Patients with a prior history of transurethral resection of the prostate (TURP) are not recommended for primary prostate cryoablation.

Dr. Waterhouse discusses the benefits of primary cryotherapy over other treatment options.

b. Salvage Prostate Cryoablation

Salvage prostate cryoablation is recognized by the American Urological Association (AUA) as a treatment option for curative intent in men who have had a recurrence of prostate cancer.

Dr. Tannenbaum discusses why salvage cryotherapy is a good option for patients with recurrent prostate cancer.

AUA’s recommended guideline on salvage prostate cryoablation includes:

  • PSA <10 ng/mL
  • Gleason score of ≤ 8
  • Clinical stage of tumor T1 or T2 (before salvage therapy)
  • Pathologic evidence of locally recurrent disease without clinical evidence of metastatic disease
  • No evidence of seminal vesicle (SV) invasion
  • A life expectancy >10 years
  • A long PSA doubling time

c. Focal Prostate Cryoablation

The EAU 2012 Guidelines of Prostate Cancer provides the following criteria to help identify candidates for ongoing trials of focal prostate cryoablation treatment:

  • Patients should ideally undergo transperineal template mapping biopsies
  • Patients with a low to moderate risk
  • The clinical stage of the tumor should be < cT2a and the radiological stage < cT2b

Patients who have undergone radiation therapy of the prostate are not recommended for focal prostate cryoablation. Patients with previous prostate surgery should also be counseled with caution because no data on functional and oncological outcomes are available.

Patients must be informed that focal prostate cryoablation is still experimental and that there is a possibility of repeat treatment.