Focal Cryotherapy and COLD Database

Heating beyond the upper thermal tolerance is the most common premise for many tissue ablative modalities (HIFU, interstitial laser). However, cryoablation uniquely takes advantage of a tissues’ inability to survive temperatures beyond the lower end of the thermal viability spectrum. Surpassing the thermal viability limits at one extreme or the other may have more significant biologic implications than just a difference in temperature. Tissue death at these two extremes involves a very different set of mechanisms and as such may illicit a very different response from the body, regionally and systemically, that could offer both therapeutic advantages and an alternate morbidity profile. This difference may ultimately provide a rationale for choosing one form of tissue ablation over another (cryoablation over HIFU, as an example). However, for now, much of the decision to work at one end or the other of the thermal viability spectrum is based upon equipment availability and the comfort level of the surgeon with the energy source. Even datum to suggest a difference in morbidity between energy sources when applied in a focally ablative manner to treat prostate cancer remains scarce. It thus behooves the surgeon interested in focally ablative techniques for prostate cancer to be familiar and competent in a variety of energy sources for tissue ablation.