Cryohypophysectomy in the management of advanced prostatic canger

Twenty patients with metastatic carcinoma of the prostate underwent stereo-taxic trans-sphenoidal cryohypophysectomy. Of the 19 patients surviving the operative procedure, 12 (63%) benefited. Seven patients (37%) experienced objective remissions, whereas 5 (26%) had subjective responses alone. The mean survival of those who responded was 11.5 months as compared with 3.8 months for those who did not. Mean duration of the remission was 7 months. Autopsies revealed a 90% or greater destruction of the anterior lobe of the pituitary in 5 of 7 cases. The calculated amount of residual anterior pituitary tissue varied from 0 to 49%; there was little correlation between the completeness of hypophysectomy and the quality or duration of the response. Complications included death in one patient, cerebrospinal fluid rhinorrhea in 3, and diabetes insipidus (transient) in 7. Cryohypophysectomy is an effective technique of pituitary ablation capable of providing a high overall remission rate in metastatic prostatic cancer.