Background: One of the important factors in assessing the treatment outcome for prostate cancer (PCa) is quality of life, which may be jeopardized by complications after treatment. In this study we present our experience with complications after primary and salvage cryotherapy of the prostate.

Methods: Between January 2002 and July 2006, 75 men with biopsy-proven PCa underwent primary cryosurgery for clinically localized prostate carcinoma and 12 patients - salvage cryoablation for radiorecurrent PCa, respectively. All men had a negative bone scan prior to treatment. All patients underwent a dual freeze-thaw cycle using third generation cryotechnology with ultra thin 17G cryoneedles. Complications were prospectively entered into a database. All but 5 procedure were done on an outpatient basis.

Results: In 15 preoperatively potent patients 7 (47%) patients recovered with ability to achieve the same level of erection to their preoperative level. The incontinence rate was low (1.1%) reported as mild (1-2 pads per day) that did not impair significantly a quality of life. No artificial sphincters were required. Three patients developed acute urinary retention after removal of the catheter Foley 1 week after cryosurgery and were catheterized again for 5-7 days with subsequent reconstitution of their voiding pattern. One patient had experienced urethral slough without clinical sequelae. One patient had transient penoscrotal edema that had spontaneously resolved. As a unusual complication, one patient developed a prostatic abscess 5 months after primary cryotherapy that was percutaneously drained and successfully treated with Trimetoprim. There were no cases of chronic pain, need to TURP, rectourethral fistula. Mean follow-up was 21 months (±8.3).

Conclusions: The presented data of the clinical application of third generation cryotherapy suggests a safe clinical application of cryoablation. The third generation of cryotechnology using 17 gauge needles is a safe treatment option for both primary and radioreccurent PCa with minimal morbidity.