Does cryotherapy work well for prostate cancer?

  In recent years, with the aging of the society, urbanization of the population, westernization of dietary structure and advancement in detection technology, the incidence of prostate cancer (PCa) in China has been on a significant rise, from 0.2/100,000 in the 1950s to 7.7/100,000 in 2000 in Shanghai, for example. In the next 10 years, the incidence rate in large and medium-sized cities in China will increase worryingly. Therefore, the prevention and treatment should be planned for the future; the advanced treatment technology and experience should be understood, studied and learned from. Argon-helium cryoablation therapy (TCAP) Pea has become one of the preferred treatment methods in Europe and the United States and other developed countries in the West, and has entered a golden period. China started later, but began to receive attention. The introduction of argon-helium cryoablation therapy in China has routinely carried out this technology, providing patients with a new option for minimally invasive treatment of prostate cancer.  The main features and efficacy evaluation: TCAP is a new minimally invasive treatment technology developed in the United States in the past 10 years or so, which is mainly guided and monitored by rectal ultrasound, using a 1.5-1.7 mm diameter cryoprobe, puncturing to the lesion through the perineum, controlling the freezing temperature from 45℃ to 120℃, and finally causing coagulative necrosis of the tumor to achieve the goal of targeted treatment. It has the characteristics of good effect, small trauma, relatively simple operation (the average operation time of local PCa is 50 min), no intraoperative bleeding, fast recovery (normal activities can be performed the next day after operation), short perioperative period and few complications, etc., and has been widely used in the United States and other clinical applications. (1) Salvage treatment: At the beginning of clinical application, TCAP was mainly used for patients with local recurrence after radiotherapy, and gradually transitioned to the first-line treatment category because of its satisfactory therapeutic effect, and has been used throughout the development process. Follow-up results showed a 5-year biochemical recurrence-free survival rate of (54.5±4.9)%. Compared with conventional methods, it showed that TCAP has remedial treatment advantages. In China, TCAP remedial therapy has important clinical application for PCa patients who have local recurrence after radiotherapy, hormone-refractory type and need local treatment. (2) Evaluation of the mid- and long-term efficacy of initial treatment: The 5-year follow-up results of 1198 patients after preferred treatment by the frozen online registry database (COLDRegistry) showed that the 5-year biochemical disease-free survival rates in the low-risk, intermediate-risk, and high-risk groups were 9l%, 78%, and 62%, respectively. lO-year follow-up results of 370 cases after preferred TCAP by Cohen et al: the 10-year negative biopsy rate was 76.96%, and the disease-free survival rates were 80.6%, 74.2%, and 45.5% for the low-, intermediate-, and high-risk groups, respectively. Thus, using the preferred and monotherapeutic approach, TCAP significantly outperformed the effect of radiation therapy and approached the effect of radical surgical procedures. Based on a large body of Level II2, II3, and III evidence-based medicine, in December 2008, the American Urological Association (AUA) issued a Statement of Best Practice for Cryotherapy of Prostate Cancer1: affirming TCAP as the preferred, salvage treatment for early PCa and agreeing that it can be a treatment option for clinically focal prostate cancer without metastasis of any grade. This establishes the important status and positive role of TCAP and provides a reliable basis for the development of this treatment technology in China.