Focal “nerve-sparing” cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency

Focal cryotherapy may be an alternative to active surveillance in men with early prostate cancer. IntroductionPSA screening has led to a dramatic increase in the incidence of prostate cancer, with the majority of cases currently diagnosed at earlier, clinically favorable stages.1 Since prostate cancer grows slowly, men diagnosed with this disease might die of causes unrelated to their cancer. Thus, active surveillance is a valid option for men who fit the recommended criteria and do not want to consider any type of invasive or radical treatments. While studies on active surveillance have shown a 10-year overall survival rate of approximately 80%, there is still a lingering concern of allowing a potentially curable cancer to progress to incurable disease before establishing definitive treatment.2,3 However, a recent prostate intervention vs observation trial (PIVOT trial) by Wilt et al 4 indicated that for men with low-risk tumors, no distinct differences were seen in overall or cancer-specific survival benefits when comparing radical prostatectomy with active surveillance. The PIVOT trial reported that 171 of 364 men (47%) in the radical prostatectomy group died, while 183 of 367 men (49%) in the observation group died. A strategy of incorporating focal therapy as definitive treatment for selected men with focal disease and clinically significant cancer may reduce the number of men who will require treatment while on active surveillance. Considered a minimally invasive treatment, questions related to focal therapy include patient selection, evaluation of treatment success, and

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“…Onik et al 16 first reported on the use of cryotherapy as focal therapy. They reported on 9 patients with an average follow-up of 3 years.…”

Section: Reported Series On Focal Cryotherapymentioning

confidence: 99%

Focal Cryotherapy in the Treatment of Localized Prostate Cancer

2013

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“…A nerve-sparing cryoablation technique to manage PCa was first described in 2002 by Onik and coworkers 33 in a pilot study of nine patients by performing unilateral ablation of the lobe where the positive biopsy was identified and leaving the contralateral lobe and neurovascular bundle untreated. After a mean follow-up of 3 years, seven patients were potent.…”

Section: Current Protocols Of Focal Cryoablationmentioning

confidence: 99%

Contemporary Results of Focal Therapy for Prostate Cancer Using Cryoablation

Mouraviev

Johansen

Polascik

2010

Journal of Endourology

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The concept of focal therapy is rapidly evolving and gaining popularity from both physician and patient perspectives. We review the rationale, candidate selection, and results of the first clinical studies of focal cryoablation for selected patients with low volume and low-to low-moderate-risk features of prostate cancer as an alternative to whole-gland treatment. In spite of improved understanding of the tumor biology of early stage disease, we currently have limited tools to select appropriate patients with low-to low-moderate risk unifocal or unilateral prostate cancer who may be amenable to focal therapy. From a technical point, a number of ablative treatment options for focal therapy are available, with cryoablation having the most clinical experience. Recently, several reports have been published from single and multi-institutional studies that discuss focal therapy as a reasonable balance between cancer control and quality-of-life outcomes. Retrospective pathologic data from large prostatectomy series, however, do not clearly reveal valid and reproducible criteria to select appropriate candidates for focal cryoablation because of the complexity of tumorigenesis in early stage disease. At this time, a more feasible option remains hemiablation of the prostate with reasonable certainty about the absence of clinically significant cancer lesion(s) on the contralateral side of the prostate based on three-dimensional transperineal prostate biopsy mapping studies. Minimally invasive, parenchyma-preserving cryoablation can be considered as a potential feasible option in the treatment armamentarium of early stage, localized prostate cancer in appropriately selected candidates. There is a need to further test this technique in randomized, multicenter clinical trials.

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“…25, 27 Ellis and coauthors 28 showed in their series of 60 patients undergoing focal cryoablation a remarkable 80.4% biochemically disease-free. Ninety-two percent of positive biopsies were from the contralateral side and were safely retreated with cryotherapy.…”

mentioning

confidence: 99%

“…Onik and colleagues 25 first coined the term "male lumpectomy" for focal ablation of PCa. As such, it appears that focal therapy is a logical extension of the AS concept because it aims to minimize the risk associated with expectant management in that the clinically threatening index cancer 26 ( Fig.…”

mentioning

confidence: 99%