Cryosurgery of the Kidney and Prostate
Indications
Cryosurgery involves freezing tissue to extremely cool temperatures (-190 Celsius) in order to kill the cells. The mechanism of this destruction includes disruption of the cell wall, organelles within the cell and destroying local blood vessels. Dermatologists have the most experience with cryosurgery for treating cancers of the skin.
Within the last decade the advent of improved cryosurgical delivery systems and advances in ultrasound guidance urologists have allowed the urologist to apply this technology for the treatment of prostate cancer. Most recently it has been employed for the treatment of small kidney cancers.
Here at New York University we have acquired the most advanced cryosurgical system available and are currently evaluating its use for the treatment of small kidney cancers and recurrent prostate cancer following radiation therapy.
Procedure
Cryosurgery of the prostate is performed trans-perineally similar to radioactive seed implants (brachytherapy). Ultrasounded guidance coupled with a perineal template allows accurate destruction of the prostate without injury to near by structures. Patients stay overnight in the hospital and our usually back to normal activities within 1 - 2 weeks.
Cryosurgery of the kidney is performed laparoscopically. Three ports are placed to allow access to the kidney and site of tumor. Using ultrasound guidance the cryoprobe is placed in the center of the lesion. The probe then is cooled to 190 Celsius destroying the lesion.
Video procedures:
Results
Several investigators including ourselves have performed and followed patients undergoing cryosurgery of kidney cancer. Operative time is short, estimated blood loss is negligible, and hospital stay is usually 2 days or less. Results in terms of cancer control are promising and with short follow-up appear similar to traditional techniques. This technique has great promise in the arsenal against kidney cancer however still requires further evaluation.
For prostate cancer patients who have failed radiation therapy cryosurgery is a promising therapeutic modality. We and other investigators are continuing to study the role of cryosurgery in prostate cancer in order to determine the best candidates for this technology.
