Cryotherapy for localised prostatic carcinoma

Focal therapy using cryoablation for localised prostate cancer:

• focal therapy using cryoablation is intended to be used in patients with localised prostate cancer - specifically patients with tumours that are confined to 1 prostatic lobe
  
  
• imaging and biopsy mapping studies are used to confirm that the tumour is suitable for focal therapy and to show its precise location
  • using local or general anaesthesia, the bladder is catheterised
  • using transrectal ultrasound and a template placed on the perineum, fine needles are inserted transperineally into the prostate
    • pressurised argon is passed through the needles to freeze the targeted area of the prostate, destroying the tissue
    • implantable temperature probes and transrectal ultrasound guidance are used to monitor the treatment, and steps are taken to protect surrounding tissue from the effects of freezing
      
      
• after treatment patients are usually followed up regularly with prostate-specific antigen (PSA) measurements, imaging, and repeated biopsies to detect recurrence
  
  
• NICE have recommended the use of this therapy but have stated "..evidence on efficacy is limited in quantity and there is a concern that prostate cancer is commonly multifocal. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research..."

Reference:

• 1) NICE (April 2012). Focal therapy using cryoablation for localised prostate cancer