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Prostate Cancer 'Lumpectomy' Tested

A new, approach to prostate cancer has reportedly fared well in early tests.

The technique, called focal cryoablation, targets tumors without harming healthy tissue. Gary Onik, MD, who tested the procedure on a small group of prostate cancer patients, calls it “lumpectomy” for prostate cancer.

The technique still needs long-term study but could be a “major and profound departure from the current thinking about prostate cancer,” says Onik, in a news release.

Onik pioneered prostate cancer cryoablation in the early 1990s, says the news release. For more than five years, Medicare has approved cryoablation of the whole prostate gland. The new technique refines that strategy, zeroing in on tumors, not the entire prostate.

“Focal cryoablation changes the whole picture in terms of complications, and the cancer control is as good as for any other treatment,” he says.

Fewer Side Effects?

Most of the men in Onik’s study showed no signs of cancer after the treatment. Out of 42 men, 40 (95 percent) had stable PSAs with no signs of cancer a year after the procedure. Three had to be retreated due to cancer remaining in untreated areas of the prostate gland.

A year after treatment, 25 of 32 men (78 percent) who did not have impotence problems before cryoablation, had maintained their potency. Incontinence and other complications were not seen, the study shows.

Up to 35 percent of prostate tumors are isolated tumors and confined to one side of the prostate, says Onik. These tumors can be treated with focal cryoablation if the findings are confirmed.

There are three main treatment approaches to localized prostate cancer. Sexual dysfunction (impotence) and urinary incontinence are possible side effects of other treatments for prostate cancer.

Impotence affects 75 percent of patients who have surgery for prostate cancer; urinary incontinence strikes 10 percent of prostate cancer surgery patients, the news release notes.

Radiation therapy such as brachytherapy(implanted radioactive seed particles), another prostate cancer treatment, has a 50 percent impotence rate over the long term, says the news release.

Watchful waitingis another approach to treatment for localized prostate cancer. It is based on the fact that localized prostate cancer advances slowly. Surveillance or observation is another option for many men.

How It Works

In focal cryoablation, a specialist called an interventional radiologist inserts a cryoprobe through the skin, using imaging technology to guide the needle to the tumor. Then, the probe circulates extremely cold gas to freeze and destroy the localized tumor.

The procedure is done under general anesthesia on an outpatient basis. Depending on the extent of treatment, patients can usually resume normal activity in a week or two, say researchers.

The technique isn’t new. Surgeons have used cryotherapy for years but advances now allow interventional radiologists to perform cryoablation through a small nick in the skin, without an operation.

The findings were reported at the Society of Interventional Radiology’s 30th annual scientific meeting in New Orleans.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: 30th Annual Scientific Meeting, Society of Interventional Radiology, New Orleans, March 31-April 5, 2005. American Cancer Society, “How Many Men Get Prostate Cancer?”