Debate over 'cold' surgery heats up.

Prostate cancer will be detected in 200,000 men this year. Radical prostatectomy, or removal of the prostate gland, remains the most widely chosen treatment, though some studies show that this aggressive approach may only be beneficial for young men with fast-growing tumors (SN: 6/5/93, p.367). Radiation therapy, used alone or in conjunction with prostatectomy, is the second choice. Still others will consider cryosurgery, a relatively new treatment that uses liquid nitrogen to freeze and kill cancer cells.

Cryosurgery is attractive to patients who like the idea of a less invasive treatment. Indeed, the procedure is being performed with increasing frequency in the United States.

According to CryoMedical Sciences in Rockville, Md., some 4,000 cryosurgeries for prostate cancer have been performed in the United States in the last 2 years. The company manufactures cryobiological tools.

"Cryosurgery is very promising in properly selected patients," says Michael Naslund, director of the Maryland Prostate Cancer Center in Baltimore.

The procedure is appealing because it involves minimal cutting, short recuperation time, little pain afterwards, and only a local anesthetic. Radical prostatectomy, on the other hand, is a major operation followed by weeks of recuperation and pain, not to mention occasional incontinence and an estimated 30 percent risk of impotence. But cryosurgery does have side effects, including a 60 percent risk of impotence within the first year after surgery.

William Catalona, chief of urology at Washington University School of Medicine in St. Louis, believes that the promising results of cryosurgery are too preliminary to be trusted. "Because of aggressive marketing, patients view this as modern, space-age treatment," he says. "In the long run, they're going to find out they made a big mistake."

Cancer of the prostate spreads throughout the gland, tending to concentrate at the top. But Catalona says cryosurgery often fails to remove all of the cancer. This might not be a problem for men in their 70s and 80s, whose slow-growing tumors may not be detectable before they die of other causes. But men in their 40s and 50s who undergo cryosurgery may suffer recurrences 10 years later, he points out.

Cryosurgery isn't for everyone, Naslund points out. "Radiation does a poor job of killing [prostate] cancer," he says. "Cryosurgery is a good alternative to radiation, but not if you're a good candidate for radical prostatectomy."