Prostate Patient Selection

Prostate Cryoablation: Clinical Indications and Patient Selection

There are two clinical applications for prostate cryoablation including:

1. Primary Prostate Cryoablation wherein the clinical goal is to totally ablate the entire gland.
2. Salvage Prostate Cryoablation for radio-recurrent disease.
   

Primary Cryoablation (Total Gland)
Total gland ablation of the prostate is the complete ablation of the prostate and periprostatic tissue with lethal ice at –40°C. It should be noted that Primary Cryoablation may be especially attractive for patients at risk for positive margins since the ice can be advanced beyond the prostate capsule. Additionally, Cryoablation is not limited by Gleason score. Finally, since the procedure can be performed under general or spinal anesthesia it may be appropriate for patients who are unable to tolerate the risks of general anesthesia. The optimal candidates for Primary Cryoablation are patients with:

• Biopsy confirmed local disease
• Low, medium or high-risk primary prostate cancer
• Stage T1 through T3
• Gland <45cc is optimal (larger glands may be amenable to treatment if downsized using androgen ablation).

Salvage Cryoablation
Salvage Cryoablation is indicated for those patients with localized disease who have failed a course of radiation therapy, either external beam, HDR, brachytherapy or a combination of radiation therapies. Medicare has approved coverage for patients who meet one of the following conditions:

• Biposy confirmed local disease and/or
• StageT2B, or below, and/or
• Gleason Score < 9, and/or
• PSA < 8ng/mL.