UroTech

During its 40-year evolution, cryoablation has overcome many technological hurdles. The physics were always there, but the technology itself was not adequate. Today, physicians remain appropriately cautious due to cryosurgery's early legacy of severe complications. Nonetheless, the technology has made enormous strides since its latest reemergence in 1992: improved ultrasound imaging; an FDA-approved urethral warmer; and, argon gas - a safer, more controllable cryogen - has replaced liquid nitrogen. The literature demonstrates that cryoablation of the prostate is as safe and efficacious as brachytherapy in selected patients.

One may or may not recall that as recently as 1988, many outspoken professionals in the medical community denied that seed implants would find acceptance. Time has proven them wrong. In much the same manner, the skeptics are now voicing their concerns about cryoablation. I predict that in a short time, these naysayers of cryosurgery will also be convinced that this novel therapy represents a clear medical and technological breakthrough.

Surprisingly, current reimbursement for cryosurgery of the prostate is only slightly less favorable than payments for radical prostatectomy. In the future, payors may begin to realize that cryosurgery can be a more cost effective means of treating many prostate cancers and contributes substantially to the long-term health and satisfaction of patients. Both brachytherapy and cryoablation provide meaningful alternatives to radical prostatectomy among older patients. In addition, cryosurgery is the treatment of choice when radiation treatment fails.

Cryoablation of the prostate is a targeted, minimally invasive surgical technique - after training, the urologist can safely perform cryosurgery with morbidity comparable to brachytherapy. In essence, the "future" for cryoablation of the prostate is "now." Every urologist should be excited about cryosurgery and its potential as urocentric technology. Moreover, all urologists should have access to both brachytherapy and cryoablation; these two state-of-the-art technologies currently represent the least invasive treatment options for localized prostate cancer. Patients who meet the selection criteria deserve these options, and urologists have a growing obligation to discuss these important therapies with their patients - many of whom will have already read about them on the Internet.

Dr. Barnett is the founder of Urology Healthcare Group / UroTech and presides as the Executive Chairman and Chief Medical Officer. He is a practicing physician with Urology Associates, a Tennessee professional corporation comprised of 25 urologists. Dr. Barnett has practiced with Urology Associates since 1974. He is a 1969 Vanderbilt University Medical School graduate. Dr. Barnett interned at Vanderbilt University, and he completed his residency at the University of Michigan. Dr. Barnett is Board Certified in Urology and is a Fellow of the American College of Surgeons.