NERVE SPARING CRYOABLATION OF THE PROSTATE FOR SELECTED MALIGNANT AND PREMALIGNANT DISEASES UNDER COMPUTERIZED ULTRASOUND/THERMO-GUIDANCE.September 1997
F. Lugnani (Contact address: firstname.lastname@example.org)
D. Chinn (Contact address: email@example.com)
Sanatorio Triestino, Trieste; *Alhambra Hospital, Aracadia, California-USA.
When potency is an issue for a patient with adenocarcinoma of the prostate staged as small and localized by means of ultrasound guided diagnostic and staging biopsies ( A1, B1, small B2 ) or also for obstructed patients with coexisting premalignant lesions ( PIN 3, atypical hyperplasia, etc.) a conservative strategy of cryoablative procedure can be considered.
Careful placement of thermocouples in the neurovascular bundles on both the side to be preserved and that to be destroyed allows the surgeon to obtain both the control of the disease and the sparing of the nerve fibres.
8 patients were treated with this technique. After 90 days 6 of them proved potent , 2 regained potency in 6 and 8 months.
All patients were checked at 6 months and 8/9 resulted negative at biopsy. 3 patients were also biopsied at 18/24 months with no evidence of residual cancer. The PSA value varied in the single cases during the post-operative period and in all but 1 patient remained below to 1.4: the present mean value is 0.3 (0.1-0.8) at 24 months of mean follow-up (10-26).
The irregular results of the PSA values may be explained with the histological changes related with the sparing technique: it has been demonstrated that some residual glandular tissue remains on the side where the neurovascular bundles have been preserved and where more cellular fibrotic tissue may also be present on versus the "treated" side where transitional metaplasia, and jalinoid tissue are visible.
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