Nerve-Sparing Cryosurgery for Prostate Cancer

A pilot study has demonstrated that limited cryosurgery, restricted to the part of the gland where the tumor is located, represents an intermediate approach for treating prostate cancer while minimizing the risk of impotence, incontinence, and rectal injury. The study was conducted by Gary M. Onik, M.D., of the Center for Surgical Advancement in Celebration, FL (Celebration Health, USA). Dr. Gary presented the results at the annual meeting of the Radiological Society of North America (RSNA) in Chicago (IL, USA).

The study involved nine patients whose initial biopsy showed cancer limited to one side of the prostate. Following the injection of saline to separate the prostate from the rectum to avoid injuring the rectum, focal cryosurgery was performed on the area of known tumor while sparing nerves and vessels on the opposite side. Combined hormone therapy was stopped postoperatively. Follow-up extended for six months to six years. Levels of prostate-specific antigen (PSA) were checked at regular intervals.

All nine patients, five of whom were at high risk of local recurrence, had a stable PSA and no evidence of cancer in follow-up. The six who agreed to a biopsy 12 months after the procedure had negative findings. Potency was preserved in all but two patients and there were no other complications, such as incontinence. Dr. Onik says 30-40% of prostate cancers are confined to one side of the gland, which means there is a large patient population for limited cryosurgery. It offers patients an intermediate approach between watchful waiting and destruction or removal of the entire gland.

"Nerve-sparing focal cryosurgery has potentially significant advantages over nerve-sparing radical prostatectomy and in fact, I think, also over brachytherapy,” Dr. Onik concluded. "It certainly deserves further study.” A prospective multi-institutional study comparing the two nerve-sparing procedures is being planned.