High intensity focused ultrasound vs. cryotherapy as primary treatment for prostate cancer

Prostate cancer is one of the most commonly diagnosed cancers. Here, we will be discussing two upcoming techniques for its management. One is cryotherapy which has returned from oblivion after nearly 150 years armed with latest technology and looking as if its full potential has been recognized now. On the other hand is high intensity focused ultrasound (HIFU), the application of ultrasound to this field is relatively new and hence a lot of excitement and hope. We searched MEDLINE (PubMed 1942-2005), reference lists of retrieved articles, urology textbooks and our own data looking for studies comparing cryotherapy and HIFU. From 81 titles or abstracts, two independent reviewers identified 50 as potentially relevant. Disagreement was resolved by discussion involving the third reviewer and we finally identified 45 articles. Full reports of 45 articles were retrieved and final selection was made by the same two independent reviewers using the same criteria as for the initial selection. Data were extracted and methodological qualities of selected studies were reviewed by two independent reviewers. Qualitative analysis and synthesis were done. Treatment options depend upon the age of patient, grade of tumor and expectations out of treatment. Patient choice governs the treatment actually to be given. It is the selection of a patient for a particular treatment option that decides how favorable the outcome is going to be. Both these techniques are relatively new and they look promising but both lack long-term data to prove their efficacy.