Objective: Clinical studies evaluating effectiveness and safety of cryosurgery (CS) for clinically localized prostate cancer (PCa) have reported conflicting results. We aim to obtain systematic and comprehensive evidence regarding the potential benefits and safety of CS compared with those of radiotherapy (RT) and radical prostatectomy (RP), respectively.
Methods: All controlled trials comparing CS with RT or RP and single-arm studies reporting results of CS therapy were identified through comprehensive searches of PubMed, the Cochrane Library and Embase, and a meta-analysis and systematic review of these studies were chosen.
Results: Ten publications from seven trials, with a total of 1,252 patients, were included for meta-analysis, which revealed no significant differences in comparisons of CS vs. RT and CS vs. RP for overall survival (OS), disease-specific survival (DSS) and biochemical disease-free survival (bDFS), except for a significantly lower bDFS for CS than RP [risk ratio (RR) 0.85, 95% confidence interval (CI) 0.73–0.99, P=0.03]. Moreover, dynamic analysis of pooled complications in months of 1, 3, 6, 12 and 24 demonstrated significantly a higher occurrence for urinary and sexual bothers in CS then RT at most disease stages. Furthermore, a systematic review of the literature focusing on comparative data of databases and materials of single-arm trials revealed satisfactory survival results in both primary and salvage CS. Furthermore, following CS, we observed an increasing incidence of 41% compared to which in the initial phase and maximum overall value of >53.3% for urinary complications; similarly, we observed an increasing incidence of 56.8% and a maximum overall value of 100% for erectile dysfunction.
Conclusions: Our results showed that CS could be an effective method for clinically localised PCa with survival results satisfactory and comparable to other modalities. However, the large percentage of complications caused by CS should be carefully monitored. Additional high-quality, well-designed randomised controlled trials and comparative studies with long-term follow-up results are required to define the options for patients with clinically localised PCa.
