Cryosurgery as primary treatment for localized prostate cancer: a
community hospital experience.
Urology Associates of North Texas, and United
States Medical Development, Arlington, Texas 76012, USA. email@example.com
The technique and recent experience incorporating
cryosurgery into our community practice for primary treatment of
localized prostate cancer is described. Between December 2000 and
December 2001, a total of 93 patients underwent targeted cryoablation
for localized prostate cancer. Of the 93 patients, 18 had failed
radiotherapy, and cryotherapy was used as salvage therapy. The remaining
75 patients underwent targeted cryoablation of the prostate as primary
therapy. A single urologist using an argon-based cryoablation system
performed the procedure. Cryoprobes and thermosensors were placed
under transrectal ultrasound guidance via a transperineal route.
A double freeze-thaw cycle was used with anterior-to- posterior
probe operation. Strategically placed thermosensors were used to
monitor and control the freezing, and a warming catheter was used
to protect the urethra. We achieved a nadir prostate-specific antigen
level of < or =0.4 ng/mL in 84% of the entire population we studied
(63 of 75 patients). Postsurgery complications were minimal. Incontinence
developed in 4 patients, as did postsuprapubic catheter removal
urinary retention. Erectile dysfunction developed in 28 of 34 patients
who were potent preoperatively, with 6 of the 34 patients regaining
potency after surgery. No rectourethral fistula formation occurred.
Urethral sloughing was observed in 5 patients, 1 of whom developed
a scrotal abscess during treatment of the sloughing. The use of
cryoablation of the prostate for the treatment of localized adenocarcinoma
of the prostate is feasible and can easily be transferred from the
pioneering centers to the community hospitals without sacrificing
safety or efficacy.
PMID: 12206846 [PubMed - indexed for MEDLINE]