Focal Cryotherapy
Prostate cancer (PCa) is the second most common male cancer globally, accounting for 14% of cancer diagnoses in men. Traditional whole-gland treatments like radical prostatectomy and irradiation, although effective, often lead to significant functional impairments. The challenge of overtreatment has led to the development of focal therapy (FT) as a minimally invasive alternative for low to intermediate-risk PCa, aiming to minimize morbidity while effectively managing cancer. Cryotherapy, an FDA-approved ablation modality, utilizes controlled freezing to induce cellular death, showing promise in focal applications. Advances in imaging, particularly multiparametric MRI (mpMRI), have enhanced patient selection for FT, identifying lesions suitable for targeted treatment. Modern cryotherapy benefits from improved imaging, third-generation cryogenic systems, and urethral warming techniques, ensuring precise and safe ablation. Patterns of ablation are often tailored to lesion characteristics. Contemporary studies highlight the efficacy of cryotherapy in achieving oncological control, with 5-year biochemical progression-free survival rates of 62–70%. Functional outcomes are also favorable, with posttreatment continence rates ranging from 95.1% to 100% and potency rates from 46.8% to 100%. Future advancements in the application of cryotherapy should focus on novel imaging techniques like the incorporation of positron emission tomography, enhanced cryo-technology, and the integration of immune enhancers to improve outcomes. Continued research and multidisciplinary approaches are vital for optimizing FT outcomes, potentially expanding its application and improving overall patient management.
