W.A. Soanes

Prospects for cryo-immunotherapy in cases of metastasizing carcinoma of the prostate☆

Abstract Clinical observations of the remission of metastatic lesions in six patients following cryothermic treatment of their primary prostatic tumor suggest that factors other than freezing may be involved in both primary and secondary cellular destruction. The precise mechanism(s) operative in the cases presented is not yet definitive; however; priliminary data are suggestive of immunologic factors. The nature of the possible immunologic process underlying these remissions is discussed.

Elution of in vivo bound antiprostatic epithelial antibodies following multiple cryotherapy of carcinoma of prostate

Abstract Antibodies reactive with the cytoplasmic membrane or intercellular areas of autologous human and monkey prostatic secretory epithelial cells have been demonstrated by immunofluorescence in an eluate prepared from prostatic tissue obtained from a patient with metastatic adenocarcinoma of the prostate following multiple cryotherapy of his primary prostatic tumor. Elution of antiprostatic antibodies provides preliminary evidence that prostatic tissue (tumor?)-specific or tumor-associated antigens are liberated into the circulation following cryotherapy of the prostate in man.

A possible immuno-cryothermic response in prostatic cancer

Two patients with carcinoma of the prostate were treated by cryo-surgical destruction of the primary tumour: regression of metastases was then observed. The implications of this “immuno-cryothermic response” are discussed.

CHEMICAL AND MORPHOLOGIC CHANGES IN THE PROSTATE FOLLOWING EXTREME COOLING

The prostate in man is a n accessory sex gland located a t the outlet of the bladder. It forms the first portion of the urethra and circumscribes the urethra. Normally, during micturition, the prostatic urethra becomes intravescalized as the detrusor muscle of the bladder contracts, thereby markedly reducing urethral resistance. The prostate is subject to pathologic changes which prevent this reduction in resistance making i t difficult to void and ultimately ending in bladder decompensation, renal failure or intolerable symptoms. These pathologic changes a re scarring secondary to inflammation of the prostate. All operative procedures designed to eliminate obstruction create the intravesiculization of the prostatic urethra by removing portions of the prostate gland. Thirty years ago, the operative intervention into this area carried a mortality rate as high as 15 per cent. Better operative techniques, adequate blood replacement, and antibiotic therapy has reduced this mortality to two per cent or less. However, mortality is still considerable, and combined with the heritage of a much higher mortality, operative intervention, fo r the most part, has been confined to those patients with bladder decompensation, kidney failure, and intolerable symptoms. These ra ther terminal indications fo r intervention suggest tha t there is room for improvement in our approach to this problem. Indeed the symptoms of moderate difficulty voiding, night-time voiding, etc., has been assumed by our older population to be a burden they must assume with years. The controlled application of extreme cold to tissue has been made possible by modern engineering advances, primarily, the development of vacuum insulation. The instrument we employ to effect surgical freezing is the Linde CE 2 Cryosurgical equipment developed initially for use of the Cooper cryosurgical system. The CE 2 is a completely integrated unit capable of furnishing cold down to -200 to the t i p of the probe. The unit consists of a vacuum-insulated liquid nitrogen container, feed line, and probe assembly, and is equipped with appropriate temperature control devices. The vacuum insulation allows all but the heat transfer surface of the probe t ip to remain at room temperature. For our first studies, the dog prostate was selected bewuse i t is readily accessible and undergoes a hypertrophy in aging canines somewhat similar t o tha t found in human beings. The anterior half of one side of the prostate was frozen. The rest was used a s a control. The probe temperature was

Clinical and Experimental Considerations of the Immunologic Response to Prostatic and Other Accessory Glands Tissues of Reproduction

In the present report two distinct but aligned areas of investigation pursued in this and other laboratories are reviewed. In the first, the experimental production of hetero-, iso-, and autoantibodies to prostatic and other accessory glands tissues of reproduction of man, monkey, canine, and rabbit have been employed to study the immunologic properties of these tissues and their possible immunopathogenicity as related to diseases of the prostate in man. In the second, the results of the experimental aspects of prostatic cryosurgery leading to the successful adaptation of the therapeutic utilization of cryosurgery for the destruction of benign and malignant prostatic tissue, particularly in the treatment of the elderly and in cases presently not amenable to the conventional methods of prostatic surgery, are presented. The possible production of an ‘immuno-cryothermic’ response to freezing and refreezing the primary prostatic tumour in cases of metastasizing adenocarcinoma of the prostate as observed by the remission of metastatic lesions in six patients so treated, possibly presents an entirely new approach to the treatment of malignant diseases through the in situ immunization of the host to his own tumour.