“Male Lumpectomy”: Focal Therapy for Prostate Cancer Using Cryoablation
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
References (22)
- et al.
Follow-up of conservatively managed prostate cancer: watchful waiting and primary hormonal therapy
Urol Clin North Am
(2003) - et al.
Prostate cryoablation: a scientific rationale for future modifications
Urology
(2002) - et al.
Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers
J Urol
(2003) - et al.
Incidence of positive surgical margins after biopsy-selected nerve sparing radical prostatectomy
Urology
(1998) - et al.
Prospective trial of cryosurgical ablation of the prostate: five-year results
Urology
(2002) - et al.
Seven-year outcomes in the primary treatment of prostate cancer
Urology
(2002) Total cryoablation of the prostate versus standard cryoablation versus radical prostatectomy: comparison of early results and the role of trans-urethral resection in cryoablation
J Urol
(1999)- et al.
Focal nerve sparing cryoablation for the treatment of primary prostate cancer: a new approach to preserving potency
Urology
(2002) - et al.
Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy
J Urol
(1993) - et al.
Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer
Int J Radiat Oncol Biol Phys
(2000)
Fifteen-year results of breast-conserving surgery and definitive irradiation for stage I and II breast carcinoma: the University of Pennsylvania experience
Int J Radiat Oncol Biol Phys
Cited by (0)
- 1
Dr. Onik holds stock in Endocare, Inc.
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Dr. Vaughan has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.
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Dr. Lotenfoe has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.
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Dr. Dineen has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.
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Dr. Brady has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this supplement.