Background: We performed a detailed retrospective analysis of the direct hospital costs of patients undergoing cryoablation of the prostate (CAP), radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and laparoscopic robotic prostatectomy (LRP).

Methods: Between January 2002 and July 2005, 462 patients underwent surgical treatment for clinically localized prostate cancer. All patients had been carefully selected based on the following criteria: clinical stage T1-2, absence of local and systemic spread, and the ability to tolerate anesthesia. The distribution of patients between surgical procedures was as follows: group-1 RRP (200 patients), group 2- RPP (n=67), group 3- LRP (n=137), group 4- CAP (n=58). The total direct hospital costs (everything related to the procedure) and pathology professional fees were analyzed for each procedure.

Results: Patients undergoing CAP of mean age 67±7 years were significantly older than those undergoing RRP (60 ±6, p=0.03), RPP (60 ±7, p=0.04) and LRP (59 ±7, p<0.0005). The mean LOS in the CAP group was significantly lower (0.16± 0.1, median- 0 days) (only 4 procedures of 58 were done on in-patient basis) than that for RRP (2.8±1.6, median-3 days), RPP (3.3±1.9, median-2 days), and LRPx (2.2±1.4, median-2 days) (p=0.01). Direct surgical costs were less in RRP ( ±) and RPP (±) groups than in technology-dependent procedures- LRP (,441±) and CAP (,895±) (p<0.05). However the total non-surgical hospital costs were much less in the CAP group (±) than in the RRP (±), RPP (± ) and LRP (,226±) groups (p<0.0005). The total direct hospital cost differences including pathologic assessment costs were less in LRP (±) and CAP (±) than in RRP (±) and RPP (±) groups, however these differences were insignificant (p>0.05). There were no pathologic costs with CAP due to its ablative nature.

Conclusions: Despite the relative increased surgical expense of CAP versus conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs are offset by significantly lower non-surgical hospital costs. The cost advantages associated with CAP include a shorter LOS in hospital, the absence of pathologic costs and need for blood transfusion.