�UroToday.com - Both cryoablation and brachytherapy are well studied alternatives to radical prostatectomy. The techniques ar similar in the coating of the needles to deliver the treatment, planning software and algorithms to achieve the best coverage, are delivered as outpatient treatment, and efficacy. The techniques disagree in that cryoablation throne be utilised for irradiation failures and can be repeated.
There is a significant body of literature on brachytherapy and the controversies ar centered around the isotope used and the dosimetry. While in that respect may be some theoretic advantages to Pd103 in high risk tumors, there is no significant clinical data exhibit an advantage over I125. Generally Pd103 is victimised in combination with external beam and I125 in monotherapy. Treatment planning bathroom be performed prior to implant (Preplan) or during the imbed (intraoperative planning). The advantage of the preplan is that the number of seeds ordered is exact, but it requires a separate visit for the planimetry and is less flexible if changes need to be made during the implant. Intraoperative planning may resultant role in order more seeds than mandatory, but results show a significant betterment in both D90 and V100 compared to preplanning.
Cryoablation has had a controversial history which has improved with the third base generation bringing devices. The needles are smaller and are able to deliver a more than precise ice ball than the prior technologies. The addition of thermocouples for monitoring temperature and the urethral cooling system device have dramatically reduced some of the worst complications antecedently reported with cryoablation including incontinence, tissue paper sloughing, and fistulae. The outcome database for cryoablation is comparatively small compared to brachytherapy, but appears equal in terms of cancer restraint at 5 years in some studies and inferior in others.1-3 Complications such as loss of sexual function and dissoluteness appear to be higher in patients undergoing cryoablation though the new course towards focal therapy may reduce these complications.4-7
There ar few studies directly comparing the 2 technologies, only QOL analysis by Hubosky et al showed that QOL next either therapy showed eq scores on both bowel and bladder function initially, but favourite cryoablation at 18 months.3 Sexual dysfunction was significantly more common with cryoablation both immediately after treatment and in thirster term watch up.
References: 1. Cohen JK, Miller RJ, Ahmed S, Lotz MJ, Baust J Ten-year biochemical disease control for patients with prostate cancer treated with cryosurgery as primary therapy. Urology 71:515-8, 2008
2. Long JP, Bahn D, Lee F, et al. Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology. Mar 2001;57(3):518-23
3. Hubosky LB, Fabrizio MD, Schelhammer PF, Barone BB, Tepera CM, Given RW, Single center experience with third-generation cryosurgery for management of organ-confined prostate cancer: critical evaluation of short-term outcomes, complications, and patient quality of life J Endourology 21:1521-1531, 2007.
4. Robinson JW, Donnelly BJ, Saliken JC, et al. Quality of life and sexuality of men with prostate genus Cancer 3 geezerhood after cryosurgery. Urology. Aug 2002;60(2 Suppl 1):12-8.
5. Cohen JK, Miller RJ, Rooker GM, Shuman BA. Cryosurgical ablation of the prostate: biennial prostate-specific antigen and biopsy results. Urology. Mar 1996;47(3):395-401
Ghafar MA, Johnson CW, De La Taille A, et al. Salvage cryotherapy using an argon based system for locally repeated prostate crab after radiation therapy: the Columbia receive. J Urol. Oct 2001;166(4):1333-7; word 1337-8.
6. Chin JL, Pautler SE, Mouraviev V, et al. Results of salvage cryoablation of the prostate gland after radiation: identifying predictors of treatment failure and complications. J Urol. Jun 2001;one hundred sixty-five(6 Pt 1):1937-41; discussion 1941-2
7. Pisters LL, von Eschenbach AC, Scott SM, et al. The efficacy and complications of salvage cryotherapy of the prostate. J Urol. Mar 1997;157
Presented by: Sam D. Graham, Jr., MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
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