To evaluate the current status of high-intensity focused ultrasound (HIFU) and cryosurgery as the primary treatment option in patients with prostate cancer.

A MedLine search using specified search terms was done on February 28, 2005. This search rendered 150 papers related to HIFU and 566 papers related to cryosurgery. Very few of these papers presented original outcome data and are included in the present review.

No controlled trial was available for analysis, and no survival data were presented. No validated biochemical, surrogate end point was available for any of the two therapies. HIFU showed progression-free survival (based on prostate-specific antigen±biopsy data) of 63–87% (projected 3- to 5-yr data), but median follow-up in the studies ranged from 12–24 mo. Negative postoperative biopsies was seen in 82–94% of patients. Complications have been reduced by the combination of transurethral resection of the prostate and HIFU. Cryosurgery showed a progression-free survival of 36–92% (projected 1–7 yr data), depending on risk groups and definition of failure. Negative biopsies were seen in 72–87%, but no biopsy data were available for the currently used third-generation cryotherapy machines. Complications seem to be lower with the third-generation machines.

None of the evaluated therapies has enough data available to support their use as an alternative to established therapies (surgery, radiation) for localised prostate cancer. Until further data become available, the use of both treatments should be restricted to patients unfit for established therapies who still have the need for local therapy.

Gunnar Aus

Department of Urology, Sahlgrens University Hospital, SE 413 45 Göteborg, Sweden

Accepted 13 July 2006 published online 31 July 2006.