The protracted natural history of clinically localized prostate cancer has confounded the development of a national consensus regarding the optimal treatment for this disease. In the AUA 2007 Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update, multiple treatment modalities are considered as options.1 This conundrum is further complicated by stage migration and lead time bias, both associated with PSA-based early detection strategies and the resultant increase in the detection of small volume clinically localized cancers.2 Since the majority of men currently diagnosed with prostate cancer are likely to have the disease eradicated by one of several treatment modalities, the clinical focus on HRQL associated with treatment has intensified.3 There are no published long-term data on the efficacy of cryosurgery on metastasis-free, prostate cancer specific, or overall survival as there are with other more established forms of therapy; however, several large, single institution experiences, a pooled analysis, and several prospective evaluation studies report the efficacy and morbidity of cryosurgery of the prostate.4–7 Additionally, prostate cryosurgery has been found to result in acceptable HRQLbased outcomes with a reduced cost when compared to other local therapeutic options.8,9 Short-term PSA relapse-free survival outcomes following cryoablation of the entire prostate comparable to radiation therapy in men with intermediate- and high-risk disease have been reported.4,7,10–13 Biochemical- free survival comparisons between RP and other nonextirpative therapies are difficult since the definitions for success are different. The inherent treatment planning flexibility of cryosurgery lends itself to a targeted subtotal gland ablation approach for men with low-risk and/or small-volume cancers.14
