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Original Article
Nerve-Sparing Cryoablation for the Treatment of Primary Prostate Cancer: the Preliminary Report - Seong Choi
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Kosin Medical Journal 2014;29(2):135-140.
DOI: https://doi.org/10.7180/kmj.2014.29.2.135
Published online: December 18, 2014
1Deparment of Urology, College of Medicine, Kosin University, Busan, Korea
- Corresponding Author : Seong Choi, Department of Urology, College of Medicine, Kosin University, 262, Kamcheon-ro, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6253 FAX: +82-51-990-3994 E-mail: schoi@ns.kosinmed.or.kr
• Received: August 21, 2013 • Accepted: December 16, 2013
Copyright © 2014 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
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Background:
- To present a pilot study of nerve-sparing cryoablation for the treatment of primary prostate cancer. Materials and Methods: Between 2008 and 2011, 9 patients underwent nerve-sparing cryoablation (unilateral 5, bilateral 4 patients). One neurovascular bundle (NVB) was spared on the side opposite the positive biopsy, and two NVBs were spared when indicated and possible. Just before the start of freezing, a 22-gauge spinal needle was placed into Denonvilliers fascia using a transperineal route, and normal saline was injected to separate the rectum from the prostate. The prostate-specific antigen (PSA) level was sampled every 3 months for the first 2 years and then every 6 months thereafter. Patients were considered to have a stable PSA if they had two consecutive PSA measurements without a rise.
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Results:
- The follow-up was 4ᄋ-months (19-66 months). All patients had stable PSA levels at last follow-up. Potency (defined as an erection sufficient to complete intercourse to the satisfaction of the patient) was maintained in 4 of 9 patients, 5 were potent with phosphodiesterase 5 inhibitors or intracavernosal injection. Conclusions: Nerve-sparing cryoablation, in which one or two neurovascular bundle is spared, showed the possibility of preserving potency in most patients without compromising cancer control. These preliminary results warrant further study.
Table 1.Patient characteristics
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Fig. 1. A schematic of the cryoprobe and warming probe placement for A,
Fig. 1.
Nerve-Sparing Cryoablation for the Treatment of Primary Prostate Cancer: the Preliminary Report
Patient characteristics
| Age (yr) | Gleason Score | Preop.PSA (ng/mL) | Positive Cores(n) | Stage | Preop.TURP/ HOLEP | Area frozen | Follow-up (mo) | Postop.PSA (ng/mL) | PSA stable | Change/Potency |
|---|---|---|---|---|---|---|---|---|---|---|
| 68 | 7 | 16.06 | 1 | T1c | No | Unilateral | 71 | 0.07 | Yes | Potent with PDE5I |
| 61 | 6 | 9.78 | 1 | T1c | No | Unilateral | 68 | 1.0 | Yes | Potent |
| 58 | 4 | 10.44 | 4 | T2a | No | Bilateral | 68 | 0.84 | Yes | Potent |
| 58 | 7 | 5.7 | 2 | T2a | No | Unilateral | 36 | 0.2 | Yes | Potent with ICI |
| 52 | 5 | 3.70 | 1 | T1c | No | Unilateral | 39 | 0.17 | Yes | Potent with ICI |
| 58 | 7 | 3.2 | 1 | T1c | Yes | Bilateral | 21 | 0.04 | Yes | Potent with ICI |
| 65 | 7 | 3.00 | 1 | T1c | Yes | Bilateral | 21 | 0.09 | Yes | Potent with ICI |
| 58 | 6 | 4.56 | 4 | T1c | No | Unilateral | 20 | 0.013 | Yes | Potent |
| 46 | 6 | 9.33 | 2 | T2a | No | Bilateral | 19 | 0.4 | Yes | Potent |
Table 1. Patient characteristics
PSA=prostate specific antigen, Stage=clinical Τ stage TURP=transurethral resection of the prostate, HOLEP=holmium laser enucleation of the prosate, PDE5l=phosphodiesterase 5 inhibi tors, ICI=intracavernsal injection.
