2 YEARS FOLLOW-UP AND HISTOPATHOLOGICAL NOTES ON CRYOABLATION THERAPY (CAT) FOR ADENOCARCINOMA OF THE PROSTATE.

CAT has been recently introduced as an alternative means to treat prostatic cancer (PC). Claimed advantages include effectiveness in treating also locally advanced cancers and the low morbidity especially if compared to the traditional treatments, i.e. prostatectomy and/or radiation therapy.
We report the results observed in 125 patients with PC treated with CAT. Pretreatment assessment was inclusive of digital rectal examination, transrectal u.s., PSA assay. Local extension of disease was estimated with multiple, 18-gauge needle, modified sextant biopsies of clinically and u.s. involved as well non involved intra- and extraprostatic sites. Patients had cancer of all stages from pT1c to and pT4. About 1/2 were within the moderate to poorly differentiated Gleason's grading scores.
Biopsy specimens were obtained from 18 different prostatic locations about 3/6-12-18/24 months after CAT or when occurred an elevation of PSA. Results were positive in 5/95-3/60-3/50 respectively, with a total projection of 83,85 % negative biopsy at 18/24 months for the entire group.
Histologic changes affected both tumoral tissue and non neoplastic gland. These consisted, in descending order of frequency, in marked fibrosis ( 76,8 % ), granulation tissue ( 56,6 % ), coagulative necrosis ( 48,6 % ), cellular swelling (25,2 % ), basal and/or squamous metaplastic changes ( 25,2 % ), lymphoid infiltrates ( 19,2 % ), nerve thickening ( 10,7 % ).
These results indicate that cryosurgery has a locally significant effect in destroying PC not only in low stage, but even in a certain number of cases with locally advanced disease.
More data are obviously needed to draw definite conclusions, however CAT appears as an interesting procedure that might represent in the future an alternative to the treatment of prostatic carcinoma.