***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE Cryosurgical ablation of the prostate is a novel therapeutic modality that induces cell lysis in the prostate by direct application of low temperatures . We have been conducting an ongoing prospect i ve pilot study of the use of cryosurgical prostate ablation in treating patients with nonmetastatic prostate adenocarcinoma since January 1993 . Results in 145 consecutive patients with mean 36 months and minimum 12 months of followup are presented . MATERIAL S AND METHODS Accrual was open to patients with clinical stages T1a to T3c prostate adenocarcinoma . Pelvic lymph node dissections were recommended but not required for patients with prostate specific antigen ( PSA ) greater than 15 ng./ml . before study entry . PSA changes , r and om prostate biopsy findings and morbidities after cryosurgical prostate ablation were recorded for each patient . RESULTS Overall actuarial rates at 42 months for maintaining PSA less than 0.3 and less than 1.0 were 59 % and 66 % , respectively . The overall actuarial progression-free rate at 60 months was 56 % . Among 160 biopsies performed 16 % showed some evidence of residual carcinoma . Overall crude rates of maintaining either a negative biopsy or PSA less than 0.3 at 6 and 24 months after cryosurgical prostate ablation were 87 % and 73 % , respectively . Significantly higher morbidities were seen in previously radiated patients undergoing cryosurgical prostate ablation compared to those with no prior radiation . Among nonradiated patients 85 % experienced no significant morbidity after cryosurgical prostate ablation . CONCLUSIONS Although preliminary , short-term outcomes after cryosurgical prostate ablation appear to be comparable to identical outcomes reported for external beam radiotherapy . Based on these results cryosurgical prostate ablation appears to be an effective therapeutic alternative for treating patients with localized prostate adenocarcinoma PURPOSE A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full dose radiation therapy and /or systemic therapy . The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen ( PSA ) levels and prostate biopsies as end points . MATERIAL S AND METHODS A total of 150 patients with locally recurrent prostate cancer following radiation , hormonal therapy and /or systemic chemotherapy underwent salvage cryotherapy using  a single  ( 71 men , mean followup 17.3 months ) or  double  ( 79 men , mean followup 10.0 months )  freeze-thaw cycle .  PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively . Complications were assessed by retrospective chart review and a mailed quality of life survey . RESULTS Overall , 45 patients ( 31 % ) had persistently undetectable PSA .  Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate ( 93 versus 71 % , p < 0.02 ) and lower biochemical failure rate ( defined as an increase in serum PSA of 0.2 ng./ml . above the nadir value , 44 versus 65 % , p < 0.03 ) than those who underwent a single freeze-thaw cycle . The main complications of salvage cryotherapy were urinary incontinence ( 73 % of the patients ) , obstructive symptoms ( 67 % ) , impotence ( 72 % ) and severe perineal pain ( 8 % ) . CONCLUSIONS Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies . A double freeze-thaw cycle appears more effective than a single cycle . Like salvage prostatectomy , salvage cryotherapy causes significant morbidity PURPOSE We examined the role of percutaneous cryoablation of the prostate in the treatment of prostate cancer . MATERIAL S AND METHODS We performed 95 percutaneous cryoablations of the prostate on 87 patients with prostate cancer . Of the patients 6 had positive lymph nodes preoperatively , radiation failed in 9 and 9 began postoperative hormonal therapy because of treatment failure . Mean patient age , prostate specific antigen ( PSA ) level ( ng./ml . ) and Gleason score were 65.4 , 12.60 and 6.03 , respectively . Median followup was 12 months ( mean 9.3 , range 1 to 24 ) . In 49 of the 87 patients ( 56 % ) the lymph nodes were evaluated before cryoablation based on the treatment protocol . RESULTS Median PSA level at 12 months was 0.55 ng./ml . ( mean 1.73 ) with a 17 % positive biopsy rate at 3 months . When the positive lymph node , radiation failure and postoperative hormonal therapy groups were removed from analysis , the median PSA level was 0.80 ng./ml . ( mean 1.86 ) with a 5 % positive biopsy rate . Of the patients in the radiation failure group 37 % had a positive biopsy at 3 months . Cases were classified according to stage , grade and PSA level , and the biopsy results were presented . The complications of percutaneous cryoablation of the prostate were review ed . CONCLUSIONS The low percentage of positive biopsies is encouraging but the significance of the persistent PSA levels remains uncertain OBJECTIVES To describe and assess the efficacy for increased gl and ular destruction by using 6 to 8 cryoprobes in place of the traditional 5 probes . METHODS In April 1996 , a revised method for cryosurgery was begun that uses 6 to 8 cryoprobes  , and by July 1997 , 81 men had been treated . This group was compared retrospectively to our last 82 cases done before April 1996 using  5 cryoprobes .  All cases were consecutive . To ensure that the groups were similar , comparison was performed of entrance prostate-specific antigen ( PSA ) , clinical stage , and Gleason score . Six months after cryosurgery , PSA and residual epithelial acini were compared between the two groups . RESULTS The two groups were comparable for all the above parameters ( P > 0.05 ) . The degree of overall gl and ular kill was greater for the 6 to 8-probe method ( P = 0.023 ) . Complete gl and ular ablation for the 5-probe and 6 to 8-probe methods was 39 % and 53 % , respectively , and the difference was not significant ( P = 0.072 ) . However , when one combined the complete gl and ular ablation group with the none to few residual acini group , 67.5 % for the 5-probe method and 88.9 % for the 6 to 8-probe method , a significant difference was found ( P = 0.001 ) . The odds of having many remaining acini versus having none to few were 3.5 times greater in the 5-probe group than in the 6 to 8-probe group . The mean and median PSA for the 5- and 6 to 8-probe groups were 0.19 and 0.1 versus 0.11 and 0.07 ng/mL , respectively , a significant difference ( P = 0.02 ) . No difference was found in rates of tumor persistence or complications . CONCLUSIONS A revised method for cryosurgery using 6 to 8 cryoprobes has proved to be more effective for near-gl and ular ablation than the traditional 5-probe method . It was easily applied , had a wide margin of safety , and even shortened learning time . These innovations have permitted a closer approach to the goal of complete gl and ular destruction OBJECTIVES Percutaneous cryosurgical ablation of the prostate ( CSAP ) was performed on patients with localized or locally advanced adenocarcinoma of the prostate . To assess local disease control , post-treatment biopsy and serum prostate-specific antigen ( PSA ) levels were obtained at 3 and 24 months post-treatment . METHODS From June 1990 through May 1994 , CSAP was performed 448 times on 383 patients under Institutional Review Board protocol s. A urethral warming catheter was used for all procedures . A total of 239 patients were followed for a minimum of 21 months after treatment . None of this group had received prior local treatment . The group consisted of patients who were newly diagnosed and treated solely with cryotherapy ( virgin ) ; the remainder had been on and rogen deprivation therapy ( ADT ) prior to CSAP .  RESULTS Biopsies were obtained from 114 patients at 21 months or more after treatment . In the virgin group , 79 % had a negative biopsy after one or more treatments , and 88 % of the ADT group are negative after one or more treatments . Overall , 69 % had a negative biopsy after one treatment and 82 % had a negative biopsy following one or more CSAP treatments . Of a group of 163 patients ,  PSA data were evaluable at 21 months or more after treatment . In the virgin group , 60 % had a PSA 0.4 ng/mL or less , and 77 % had a PSA 1.0 ng/mL or less . In the ADT group , 40 % had a PSA 0.4 ng/mL or less , and 69 % had a PSA value of 1.0 ng/m Lor less . Complications were minimal , the most common one being urethral tissue sloughing , which occurred in 10 % of patients . CONCLUSIONS CSAP appears to be effective in obtaining local control as measured by biopsy and PSA 21 months or more post-treatment . When retrospectively comparing our results with recently published radiotherapy series , CSAP was more effective in obtaining nadir PSA values 1.0 ng/mL or less and negative biopsies at 21 months or more after treatment OBJECTIVE To study the complications and oncological outcome after cryosurgical ablation of the prostate ( CSAP ) . METHODS Fifty-four patients with prostate cancer were entered into this prospect i ve phase II trial of CSAP . Patients were followed with serum PSA determinations , follow-up biopsies at 3 - 6 months postoperatively and a question naire to assess complications . A PSA of > 1 ng/ml or a positive biopsy was interpreted as progression . RESULTS Mean follow-up was 58.5 months . Patients needed a  suprapubic catheter postoperatively for in mean 18 days . Transient penile numbness occurred in 15 % . Bothersome sloughing of dead tissue was noticed by 15 % of patients and 15 % needed a transurethral resection . Nine patients ( 17 % ) developed strictures and five patients stone formation in the prostatic urethra . One patient developed a perennial fistula . Thirty-nine out of 43 patients reporting on potency become impotent , nine patients developed a slight stress incontinence and one severe incontinence . At median follow-up , the actuarial progression-free survival was 38.9 % . Fourteen out of 50 patients biopsied ( 28 % ) had remaining cancer in their prostates . CONCLUSION High complication rates in combination with poor oncological outcome has made us stop using this treatment modality OBJECTIVES To determine in a prospect i ve pilot study the safety and efficacy of cryosurgical ablation for localized prostate carcinoma . METHODS A total of 87 cryosurgical procedures were performed on 76 consecutive patients between December 1994 and February 1998 . All patients had histologically proved adenocarcinoma of the prostate , with prostate-specific antigen ( PSA ) readings of less than 30 ng/mL.  Clinical evaluations , PSA determinations , and patient self-reported quality -of-life question naires ( functional assessment of cancer treatment-prostate ; FACT-P ) were used to determine biochemical and clinical disease-free status and complications . Patients had a mean follow-up of 50 months ( minimum 36 ) . RESULTS Follow-up biopsies were performed in 73 patients , and 72 were negative for malignancy after one or more treatments . Ten patients required two treatments and 1 patient required three treatments . The 5-year overall and cancer-specific survival rate was 89 % ( 95 % confidence interval , 83 % to 97 % ) and 98.6 % ( 95 % confidence interval , 96 % to 100 % ) , respectively . The undetectable PSA rate ( less than 0.3 ng/mL ) for low-risk patients ( n = 13 ) was 60 % at 5 years ; for moderate-risk patients ( n = 23 ) , it was 77 % , and for high-risk patients ( n = 40 ) , 48 % . The corresponding percentage of patients with a PSA level less than 1.0 ng/mL at 5 years was 75 % , 89 % , and 76 % . Sloughing occurred in 3 patients ( 3.9 % ) , incontinence in 1 ( 1.3 % ) , and testicular abscess in 1 ( 1.3 % ) . At 3 years , 18 ( 47 % ) of 38 patients capable of unassisted intercourse at the time of cryosurgery had resumed sexual intercourse , 5 spontaneously and 13 with sildenafil or prostagl and in . CONCLUSIONS The results of this prospect i ve evaluation show cryosurgery to be both a safe and an effective option in the treatment of localized prostate cancer The current study was design ed to describe the long-term life quality 
    Output:
    
Cryotherapy offers a potential alternative to st and ard therapies for the primary treatment of localised prostate cancer .