Salvage cryosurgery-how I do it

Abstract

Prostate cryosurgery has advanced over the last decade, and is now recognized as a treatment option for patients who have failed radiotherapy. Appropriate patient selection is imperative for successful salvage. Because the treatment is a local therapy, the recurrent cancer must be confined to the prostate and its immediate area, and up to half of patients who undergo salvage cryotherapy may eventually fail treatment because of occult synchronous metastases. Yet some patients with poor prognosticators may still benefit from salvage treatment.

Figure 1

Schematic representation of probe placement, viewed in transverse plane. Thermocouples are placed at left and right neurovascular bundles (LNVB, RNVB) and in the midline at the apex, posteriorly.

Figure 2

Ultrasound images of saline injection. (A) Coronal view of saline being injected, separating the prostate from the anterior rectal wall. (B) Transverse view of saline, showing the extent of separation between prostate and rectum.