Rationale for a "male lumpectomy," a prostate cancer targeted approach using cryoablation: results in 21 patients with at least 2 years of follow-up.
BACKGROUND
Prostate cancer in men raises many of the same issues that breast cancer does in women. Complications of prostate cancer treatment, including impotence and incontinence, affect the self-image and psyche of a man no less than does the loss of a breast in a woman. We present a pilot study in which 21 patients were treated with a focal cryoablation procedure.


METHODS
Focal cryoablation was performed using biplane transrectal ultrasound if the tumor was confined to only one prostate lobe. Preoperative PSA values were recorded. Cryoablation was planned to encompass the area of known tumor. PSA values were obtained every 3 months for 2 years and every 6 months thereafter. Potency and continence status was obtained at the same intervals. Routine biopsy was obtained at 1 year.


RESULTS
Twenty-one patients had focal cryoablation. Follow-up ranged from 24 to 105 months with a mean of 50 months. Twenty of 21 (95%) patients have stable PSA values with no evidence for cancer, despite 10 patients being at medium to high risk for recurrence. All patients biopsied (n = 19) were negative for tumor. Potency was maintained in 17 of 21 patients (80%). No other complications, including incontinence or fistula formation, were noted.


CONCLUSIONS
These preliminary results indicate a "male lumpectomy," in which the prostate tumor region itself is destroyed, appears to preserve potency in a majority of patients and limits other complications, without compromising cancer control. If these results are confirmed by further studies and long-term follow-up, this treatment approach could have a profound effect on prostate cancer management.
Onik
Gary
G
Division of Surgical Imaging, Center for Surgical Advancement, Department of Radiology and Urology, Celebration Health/Florida Hospital, Celebration, FL 34747, USA. onikcryo@aol.com
D000368:Aged; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods*; D007172:Erectile Dysfunction / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011467:Prostate / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods; D014549:Urinary Incontinence / Q000517:prevention & control
D017430:Prostate-Specific Antigen