Cryotherapy for Management of Prostate Cancer
The aim of focal therapy for prostate cancer is targeted treatment of the clinically significant cancer foci to preserve the genitourinary function. In recent years, advances in training and safety measures have increased the clinical adoption of prostate cryotherapy as an organ conservation minimally invasive cancer surgery. This modality has been increasingly used in both primary and salvage settings, and for both whole and partial gland templates. In this chapter, the authors reviewed the literature comprehensively and covered different aspects of prostate cancer cryotherapy. The pathophysiology of cryotherapy and the rationale for the effectiveness of cryosurgery on cancer cells have been addressed. In another section, the authors focused on the details of proper case selection, surgical technique, outcomes, and complications. Notably, several technical challenges, tips and tricks, and oncological and functional outcomes in different scenarios have been discussed. Different follow-up protocols after surgery for detection of recurrence and management of recurrence after cryotherapy are presented. With evolving role of multiparametric MRI as a noninvasive modality for detection of clinically significant prostate cancer foci, the incorporation of modern imaging modalities in patient selection, for decision-making in ablative therapy as well as designing and surveillance of patients after treatment to detect post-ablation recurrence, has been extensively assessed. Finally, novel concepts and new areas of investigations in prostate cryotherapy, such as interaction with the tumor microenvironment, resistant tumor stem cells, mutations in tumor cell lines, and the use of adjuvant cryosensitizing agents, are reviewed.
