The so-called "male lumpectomy" - a minimally invasive
interventional radiology treatment for prostate cancer - is as
effective as surgery in destroying diseased tumors and can be
considered a first-line treatment for patients of all risk levels and
particularly those who have failed radiation, according to studies
released at the Society of Interventional Radiology's 34th Annual
Scientific Meeting.
Additionally, the use of 3-D transperineal mapping biopsy for
determining the extent of prostate cancer - when compared with the
commonly used transrectal ultrasound (TRUS) biopsy - heavily impacted
how patients' disease was managed in 70 percent of the cases.
"Our data show that focal cryoablation is as good for prostate
cancer control as any other treatment - including surgery, radiation
and hormone therapy - but it is less invasive and traumatic for
patients, preserves sexual and urinary function and has no major
complications. Interventional radiologists tailor treatment to each
patient's disease. Instead of removing the entire prostate, or freezing
the entire prostate or using radiation on the entire prostate,
interventional radiologists can find out where the cancer is and just
destroy the cancer," said study author Gary M. Onik, M.D.,
interventional radiologist and director of the Center for Safer
Prostate Cancer Therapy in Orlando, Fla. "We've reached a tipping
point: treating only the tumor instead of the whole prostate gland is a
major and profound departure from the current thinking about prostate
cancer," added Onik. With cryoablation, interventional radiologists
insert a probe through the skin, using imaging to guide the needle to
the tumor; the probe then circulates extremely cold gas to freeze and
destroy the cancerous tissue. This minimally invasive treatment targets
only the cancer itself, sparing healthy tissue in and around the
prostate gland rather than destroying it, as traditional approaches do,
noted the professor at the University of Central Florida. "You can go
home on the same day of the procedure, and you can repeat the
treatment, if needed, in later years," said Onik. Additionally, Onik
presented results of a 3-D biopsy method that provides superior
information on the extent and grade of prostate cancer as opposed to
the current standard TRUS biopsy.
Calling focal cryoablation a "male lumpectomy" reflects the origins
of this approach in the breast-sparing surgery that replaced radical
mastectomy as the preferred treatment for breast cancer, said Onik.
Unlike breast lumpectomy, a surgical lumpectomy for prostate cancer is
not technically feasible; so to treat just a portion of the prostate,
minimally invasive cryoablation is needed. Cryoablation (or cryo or
cryotherapy) spares as much as possible of the prostate gland and its
neurovascular bundles, limiting the side effects of bladder control
problems (incontinence) and erectile dysfunction (impotence) that
result from more radical prostate cancer treatments. It also represents
an advantage over "watchful waiting," because all treatment options are
preserved. "Any risks are fewer and lesser in intensity than surgery;
so if you have the equivalent chance of cancer being cured with far
less chance of having any complications, why wouldn't you choose it?"
asked Onik.
"There is no question that we can eradicate prostate cancer (when
that cancer has not spread to other parts of the body) by freezing it
and that there is a better way to 'map' the disease," said Onik. He
studied 120 men who had focal cryoablation over the past 12 years,
including testing the levels of prostate-specific antigen (PSA) in the
blood. Of those patients, 112 (93 percent) had no evidence of cancer -
in spite of 72 being labeled medium to high risk for cancer recurrence.
"There were no local recurrences in the areas we treated, and with the
ability to re-treat the 7 percent of patients who developed a focus of
cancer at a different site in the gland; cryoablation was 100 percent
effective in local control of the patient's disease," said Onik. He
reported that 85 percent of the men retained sexual function. Of those
who did not have previous prostate surgery, all remained continent.
"Incontinence becomes a big issue with many patients. For some it's a
more important side effect than impotence," said Onik.