Prostate cancer is third in incidence in the male population, just behind lung and colon cancer. With 250,000 cases diagnosed and an associated 40,000 deaths per year in the United States, prostate cancer represents a major development opportunity for the radiologist practicing interventional oncology. There are now low-morbidity image-guided treatment alternatives that are well suited to interventional radiologists committed to developing a patient-oriented practice.

With the decision of the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration [HCFA]) in 1999 to approve prostate cryoablation for the treatment of primary prostate cancer, treatment options for patients were expanded (1). Despite decades of investigation and incremental improvements in both radical prostatectomy (RP) and radiation therapy, neither treatment modality has distinguished itself as the procedure of choice for treating primary prostate cancer. Both modalities have limitations in treating patients with higher stage and Gleason grade disease. Also, the associated complications of RP and radiation therapy, although different in character, are not appreciably different in incidence, allowing one to definitively recommend one treatment over the other. As a result, each approach can be justifiably recommended as the procedure of choice. These options, along with “watchful waiting” (2) or, as it is now called, “active surveillance,” as possible strategies for prostate cancer management have led to patient confusion and frustration. Adding cryoablation as still another treatment option to this already confusing environment further complicates patient choices.