1666 CRYOSURGICAL ABLATION OF PROSTATE FOR LOCALIZED ADENOCARCINOMA

5. Cox, R. L. and Crawford, E. D.: Complications of cryosurgcal ablation of the prostate to treat localized adenocarcinoma of the prostate. Urology, 45: 932, 1995.

EDITORIAL COMMENT The authors present the results of percutaneous prostatic cryoa-

blation in 63 of 104 patients with localized prostate cancer. Although the treatment group was generally composed of favorable patients, 37% were categorized as having stage T3 disease. Only 1 patient received neoadjuvant therapy, reflecting perhaps that prostate size and cancer extent were limited. Of the patients 75% had negative sextant biopsies during short-term followup. Ten of the 16 patients with positive biopsies underwent a second procedure and 7 of these subsequently had negative biopsies. Therefore, the local disease-free rate following 1 or 2 procedures was 95%. Interestingly, only 19% of the biopsies showed benign epithelial elements, which is less than that noted in our larger series (although our population is composed of patients with more advanced disease). The authors also report posttreatment PSA values, which are of considerable importance after this treatment modality than they are for patients treated with

surgery or radiation. Of the patients 59% had PSA values less than 0.5 ng./ml. The percentage of patients with undetectable or low PSA values appears to have remained stable until a t least 12 months. in other reports, bladder outlet obstruction was the most common complication of the procedure. The authors and others noted that this complication is directly related to the urethral warmer design, Unfortunately, potency rates were not reported. This series and others have shown that cryosurgical ablation of the prostate results in epithelial destruction, and that continued honest and objective evaluation of this treatment is warranted. Many technical issues must be resolved, including the proper design of the urethral warm- ing device, use of thermocouples for monitoring the freezing process, adequacy of freezing of the prostatic apex and seminal vesicles, and the use of neoadjuvant deprivation. Longer followup will be required before the role of this treatment in the management of localized prostate cancer can be defined.

Peter R. Carroll Department o f Urology University of California San Francisco, California