From: Proceedings 10th World Congress of Cryosurgery
Eco thermo-guided transperineal prostatic cryoablation of the prostate for adenocarcinoma - an experience with 102 patients

November 1998
F Lugnani, Trieste, Italy; P Derakhshani, Cologne, Germany; C d'Hondt, Antwerpen, Belgium; M. Polito, Ancona, Italia; I Guercini, Perugia, Italia

Introduction and Objectives: Since 1991, cryosurgery has been introduced as a minimally-invasive alternative in the localized treatment of prostate cancer. Improvements in technology and the introduction of transrectal ultrasound allow a thermo-induced destruction of the gland and of selected periglandular areas with greater accuracy and reproducibility than in past experiences.

Materials and Methods: We present the experience with this innovative technique in 102 patients operated in different European centers, in terms of control biopsies and complications. The patients were studied completely including a laparoscopic pelvic lymph node dissection if the starting PSA was above greater than 10 ng/ml. The cryoablative procedure is carried out with 2 cycles of freezing with ultrasound guiding with multiple thermometric control. The urethra is preserved with the use of a specific urethral warmer.

Results: The treatment was on I I patients at stage T 1, 3 8 at T2, 46 at T3 and 7 with locally advanced illnesses. 79% of the patients received a cycle of neoadjuvant preoperatory therapy in order to reduce the glandular volume. There were positive results for residual glandular tissue (benign or carcinoma) 12.5% (1/8) of the patients at T I stage, 10.7% (3/28) of T2 and 22.9% (8/35) of T3. The PSA values after 6 months were under I ng/ml in 66.2% and under 0.5 in 56.3%. Erection deficit in 71.9%. 14.6% of the patients had a prolonged urine retention and 6 patients needed a TUR. Scrotal edema appeared in 41.7% of patients, but a spontaneous and rapid solution to the problem was experienced in all cases. In 7 patients, there were different levels of incontinence, two of these patients had previously undergone radiotherapy treatment. There were 2 rectourethral fistulas which were solved with conservative therapy. One patient had an abscess periprostatic which required drainage.

Conclusions: Considering that the results reported here belong to the first experiences in the different centers and are, therefore, subject to an initial learning curve, we believe that, even through an analytic evaluation, cryosurgery is, to say the least, a possible option in patients at high operating risk or when the illness is not easily dominated using traditional surgical techniques. Only the follow-up at 10/15 years and prospective studies will bring forth further elements for judgement.


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