Patients who undergo radical open or robotic surgery and have high Gleason's score and/or cancer close to the capsule will have a 30% or greater chance that cancer cells reach and trespass the capsule and go outside the capsule to the periprostatic area (stage C-2) and to the bed where the prostate had been. These cancer cells will remain there after the prostate gland had been surgically removed and could be the reason for the cancer relapse and post-op elevation of the PSA. Another reason could be the microscopic metastasis not able to be radiological detected before surgery.

Cryotherapy will destroy the cancer cells that remain in the bed of the prostate, but in the process, also will affect the nervi erigendi and produce impotence, temporal in patients below the age of 70, and possibly permanent in patients 70 and over. In my point of view, in the fight against cancer, the most important outcome is the preservation of life.

Because of this capability of cryotherapy to reach the bed of the prostate, the comparative results with those patients (pathological C-2) who went for open or robotic surgery are superior above 12 years of follow up.

If patients have a Gleason score of 10, they have an almost 100% chance of metastasis even if in a few of them, all the metastatic work up comes negative. In cases where the Gleason's score is 9, those patients have a 90% chance of metastasis. If the Gleason's score is 8 (5+3), those patients have an 80% chance, and subsequently, it is advisable to start with antiandrogens therapy at least 6-8 weeks before surgery.

In patients with a negative radiological metastatic work up, but with a pathological biopsy report of perineural involvement with cancer cells, it is better to consider this finding as microscopic metastasis and treat weeks before procedure with antiandrogen therapy, otherwise metastasis will appear 2-3 years later.

Patients with a moderate amount of prostatic stones are not good candidates for cryotherapy.

It is important to perform prostatic biopsies post cryotherapy at 6 months to be sure there is no more evidence of cancer, and PSA every 6 months for 5 years. To be declared cure, patients need to have negative biopsies (6 to 8 biopsies in each lobe), and PSA results below 0.5 mg/mL for 5 years of follow up. Also, on prostatic exams after 6 months, the prostate should be very small, flat and uniform, with a mild fibrotic consistency.