Nerve-Sparing Cryoablation for the Treatment of Primary Prostate Cancer: the Preliminary Report

Article information

Kosin Med J. 2014;29(2):135-140

Publication date (electronic) : 2014 December 18

doi : https://doi.org/10.7180/kmj.2014.29.2.135

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 2013 August 21; 2013 October 25; Accepted 2013 December 16.

Abstract

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.

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.

Keywords: Cancer; Cryoablation; Potency; Prostate

Fig. 1.

A schematic of the cryoprobe and warming probe placement for A,

Table 1.

Patient characteristics

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Fig. 1.

A schematic of the cryoprobe and warming probe placement for A,

Table 1.

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

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.