Focal "nerve-sparing" cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency.
OBJECTIVE
To present a pilot study in which 9 patients treated with focal, unilateral nerve-sparing cryosurgery were followed for up to 6 years. Cryosurgery, in which the whole gland is frozen, has a high rate of impotence, similar to non-nerve-sparing radical prostatectomy.


METHODS
Before focal nerve-sparing cryosurgery, all patients underwent repeated biopsy on the side opposite the previous positive biopsy. One neurovascular bundle was spared on the side opposite the positive biopsy. Just before the start of freezing, a 22-gauge spinal needle was placed into Denonvilliers fascia using a transperineal route, and saline was injected to separate the rectum from the prostate. Combined hormone therapy was stopped in all patients postoperatively. The prostate-specific antigen (PSA) level was obtained every 3 months for the first 2 years and then every 6 months thereafter. Patients were considered to have a stable PSA if they had two consecutive PSA measurements without a rise. All patients were strongly encouraged to undergo routine biopsies despite a stable PSA level.


RESULTS
Between June 1995 and November 2000, 9 patients underwent focal, nerve-sparing cryosurgery. The follow-up ranged from 6 to 72 months (mean 36). All patients had stable PSA levels at last follow-up. Six patients routinely biopsied had negative biopsies. Potency (defined as an erection sufficient to complete intercourse to the satisfaction of the patient) was maintained in 7 of 9 patients.


CONCLUSIONS
Focal nerve-sparing cryosurgery, in which one neurovascular bundle is spared, appears to preserve potency in most patients without compromising cancer control. These preliminary results warrant further study.
Onik
Gary
G
Division of Surgical Imaging, Department of Surgery and Urology, Center for Surgical Advancement, Celebration Health, Florida Hospital, Celebration, Florida 34747, USA.
Narayan
Perinchery
P
Vaughan
David
D
Dineen
Martin
M
Brunelle
Richard
R
D000368:Aged; D003452:Cryosurgery / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000098:blood supply / Q000294:innervation / Q000502:physiology; D010865:Pilot Projects; D011467:Prostate / Q000000981:diagnostic imaging / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional