Abstract

Introduction. Prostate cancer is a disease with major social and economic impact, therefore the development of minimally invasive therapeutic methods is highly important worldwide. Prostate crytherapy fulfills the requirements and was exten- sively developed in the USA . Material and method. We carried out a prospective study of 556 patients with prostate adenocarcinoma, treated by US-guided transperineal primary prostate cryotherapy between October 2006-July 2010 at the Institute of Urology and Renal Transplantation of Cluj-Napoca and the Lukmed Urology Clinic. Prostate cryo- ablation was performed using the Oncura 200 Golden SeedNet 2 cryotherapy system, based on argon cooling and active heating with helium, and which may use up to 25 cryotherapy needles simultanoeusly and 5 temperature sensors. The study included patients with stage T1c-T3a tumours, without metastases or severe urinary obstruc- tion (IPSS<30), and with no history of abdomin-perineal resection for colorectal cancer or rectal stenosis. We assessed the early and late complications of this procedure. Results. The patients in the study group were followed up for 12 to 54 months, mean period 31.6 months. The patients’ age ranged between 50 and 89 years, mean age 65.96 years. The most frequent complications of cryotherapy were perineal echymosis (59.9%), lower urinary tract symptoms (33.1%) and scrotal echymosis (27.2%). Rectal or pelvic pain occurred in 9.2% of cases, penile hypoesthesia in 3.6%, urinary tract infection in 9.7%, while urethral stricture was 3.4%. Erectile function one year after the operation was preserved in 303 patients (54.7%), while in 251 (45.3%) it worsened. Severe complications rate was minimal (one patient, representing 0.2%). Urinary incontinence after 3 months was noted in only 2.9%. Intestinal occlusion and hydronephrosis respectively were not reported in this group. Conclusions. Prostate cryotherapy is a valid therapeutic option for prostate cancer; increasing the efficiency of the procedure will further reduce postoperative complications. Moder cryotherapy equipment and use of fine cryotherapy needles (IceRoad), together with controlled freezing of the tumoral tissue, have opened a new era in the treatment of prostate cancer, with minimal complications.

Keywords

primary cryotherapy, prostate cancer, postoperative complications, minimally invasive procedure