Active rectal wall protection using direct transperineal cryo-needles for histologically proven prostate adenocarcinomas.
OBJECTIVE
Cryosurgical ablation of the prostate is a promising new modality for the treatment localized prostate cancer. However, better protection of the rectal wall during cryoablation of the peripheral zone of the prostate (PZP) may permit deeper freezing of the PZP and for longer time, rendering the procedure safer and more effective. We present a modified cryoablation technique of the prostate using the SeedNet system (Galil Medical, Uniondale, NY, USA), in which the rectum is actively protected during cryoablation.


METHODS
During a 12-month period, 31 patients (32 procedures) with localized and histologically proven prostate adenocarcinoma of various stages and grades were treated in this fashion. We evaluated the feasibility of a new method of active rectal wall protection during cryoablation of the prostate. Fourteen ultrathin, 17-gauge, probes, cryo-needles were percutaneously introduced under transrectal ultrasound (TRUS) guidance into the prostate. Peripheral region of the prostate and the area between the prostate and rectal wall were real time monitored for temperature changes. Two cryo-needles placed between the prostate and rectal wall served for active warming using the thawing mode when the temperatures dropped to approximately 0 degrees C, and rectal lumen washing with hot water (+40 degrees C) when the temperature reading dropped further to -8 degrees C or -10 degrees C.


RESULTS
Active protection of the rectal wall using the cryosurgical modification of active thawing by the two additional cryo-needles placed in the space between the prostate and rectum, while freezing the prostate was performed in every patient, thus enabling us a safe generation of an iceball at the peripheral zone of the prostate with an average temperature ranging from -35 degrees C to -60 degrees C, for 10 min per cycle. During a follow-up of up to 18 months (mean 13.2 months) there was a PSA decrease to values equal or less than 0.5ng/ml in 25 patients (80.6%) and to values equal or less than 1 ng/ml in 21 patients (67.7%). There were no cases of rectal injury or postoperative rectal pain in any of these patients.


CONCLUSIONS
This new cryotechnique of active rectal wall protection during cryotherapy of the prostate was safe and simple to perform, resulting in no rectal injuries. It was also very effective in ablating the prostate gland, as expressed by the low follow up PSA values.
Cytron
Shmuel
S
Department of Urology, Barzilai Medical Center, Hahistadrut 1 St., 78306, Ashkelon, Israel. cytron_md_uro@hotmail.com
Paz
Adrian
A
Kravchick
Sergei
S
Shumalinski
Dimitri
D
Moore
Jan
J
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005500:Follow-Up Studies; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D009339:Needles; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000293:injuries*; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen