In the early 1990s, prostate cryosurgery experienced a revival as a result of technical advancement in transrectal ultrasound and improved knowledge of cryobiology. However, years of experience have shown cryosurgery to be significantly inferior to radical prostatectomy and radiation therapy. Shinohara etal. reported PSA failure of up to 48% of patients with PSA nadirs between 0.1 and 0.4 ng/ml at a follow-up of <2 years.43 Cohen et al. reported a 60% biochemical NED rate 21 months or more after treatment.44 These results are roughly 30% less than what would be expected with RP. In addition, when compared to surgery, the complication rate of cryosurgery appears unacceptably high. Impotence is almost a universal complication of the procedure. Approximately 10% of cryosurgery-treated patients experience urethral sloughing. Incontinence rates up to 15% have been reported. Even worse, the complication of rectourethral fistula may occur in up to 3% of cases.43-44
With a success rate of almost 30% less than RP and a higher complication rate, cryosurgery should not be considered as a viable option for the vast majority of patients with newly diagnosed prostate cancer. It is obvious that at this point of time, RP offers patients with localized disease a significantly superior and more durable treatment outcome with less morbidity.
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