Elsevier

Urology

Volume 70, Issue 6, Supplement 1, December 2007, Pages S16-S21
Urology

“Male Lumpectomy”: Focal Therapy for Prostate Cancer Using Cryoablation

https://doi.org/10.1016/j.urology.2007.06.001Get rights and content

The introduction of breast-sparing surgery (ie, “lumpectomy”) revolutionized the management of breast cancer. The use of lumpectomy showed that quality of life could be optimized without compromising treatment efficacy. Complications of prostate cancer treatment, including impotence and incontinence, adversely alter the male self-image similarly to the way the loss of a breast does for a woman. Traditional thinking holds that prostate cancer is multifocal and therefore is not amenable to focal treatment. However, histopathologic findings from published data have indicated that up to 25% of prostate cancers are solitary and unilateral. Furthermore, the significance of minute secondary cancers might be minimal. These observations raise the question of whether certain patients can be identified and treated with a limited “lumpectomy.” In this study, focal cryoablation has been used to ablate the area of known cancer as determined by staging biopsies. The serum prostate-specific antigen (PSA) concentration was obtained every 3 months for 2 years and every 6 months thereafter. American Society for Therapeutic Radiology Oncology (ASTRO) criteria for PSA recurrence were used. A total of 55 patients with ≥1 year of follow-up had undergone focal cryoablation. Follow-up ranged from 1 to 10 years (mean, 3.6 years). At the original transrectal ultrasound biopsy, the mean and median numbers of cores taken were 9.9 and 10 (SD, ± 3.5), respectively. Mean and median numbers of positive cores were 1.8 and 1 (SD, ± 1.3), respectively. Of the 55 study patients, 52 (95%) had stable PSA levels with no evidence of cancer despite a medium to high risk for recurrence in 29 patients. All biopsy findings were negative among the 26 patients with a stable PSA level who had undergone routine biopsy at 1 year. No local recurrence was noted in treated areas. Potency was maintained in 44 (86%) of 51 patients. Of the 54 patients without previous prostate surgery or radiotherapy, all were continent. These preliminary results indicate that “male lumpectomy”—in which the prostate tumor region itself is destroyed—preserves potency in most patients and limits other complications (particularly incontinence) without compromising cancer control. Additional studies and long-term follow-up are needed to confirm that this treatment approach could have a profound effect on prostate cancer management.

Section snippets

Patient Selection

Patients were considered for cancer-targeted cryoablation if, as determined through transrectal ultrasound–guided biopsy, cancer was confined to 1 side and maintenance of potency and/or continence was a major concern of the patient. All patients provided routine cryosurgical informed consent. All patients were informed of the additional risk that untreated cancer may remain in unfrozen tissue. Patients enrolled after February 1, 2000 signed an additional consent form for the use of these data.

Results

From June 1995 to December 2005, 93 patients underwent cancer-targeted cryoablation. Of these, 55 had not had radiotherapy failure and had undergone ≥1 year of follow-up (mean follow-up, 3.6 years). Mean and median numbers of cores taken at transrectal ultrasound–guided biopsy were 9.9 and 10 (SD, ± 3.5), respectively. The mean and median numbers of positive cores were 1.8 and 1 (SD, ± 1.3), respectively. Using accepted criteria to stratify patients according to risk for recurrence (PSA level

Discussion

The main theoretical objection to focal therapy is that prostate cancer is often multifocal. As with breast cancer, however, prostate cancer consists of a spectrum of diseases, some of which might be amenable to focal therapy. Prostate cancer pathology data have shown that a significant number of patients have a single focus of cancer, and that many others have additional foci that might not be clinically significant.4, 5, 6, 7 Until now, however, little attention has been paid in trying to

Conclusion

Study results reported here demonstrate that a procedure that targets the cancerous portion of the prostate (ie, a “male lumpectomy”) can provide good cancer control while limiting patient morbidity. Additional prospective studies, with larger numbers of patients and longer follow-up periods, are needed to evaluate the full implications of such a treatment approach. During this time, when patients must choose between “watchful waiting” and high-morbidity whole-gland treatments, a lumpectomy

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  • Cited by (0)

    1

    Dr. Onik holds stock in Endocare, Inc.

    2

    Dr. Vaughan has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.

    3

    Dr. Lotenfoe has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.

    4

    Dr. Dineen has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.

    5

    Dr. Brady has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.

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