Focal prostate cryoablation is the less-than-complete ablation of the gland with ice. The known tumor is ablated aggressively, whereas contralateral prostate tissue and surrounding structures are spared. This method offers targeted local cancer control aiming at sexual potency and urinary continence preservation in patients whose prostate cancer is believed to be unilateral.
Patients who have a strong desire to preserve sexual function and continence may be candidates for focal cryoablation. Focal Cryoablation is a treatment option for clinically organ-confined, unilateral tumor identified by color Doppler ultrasonography and confirmed by targeted and systematic biopsy.
Focal cryoablation can provide biochemical and local control of prostate cancer while preserving potency and continence.
Before the widespread use of prostate specific antigen (PSA) screening, most cases of prostate cancer were diagnosed at a locally advanced or metastatic stage, beyond the point were a cure was possible. The advent of widespread PSA screening in the 1980s has resulted in a downward stage migration, with most cases of prostate cancer now being diagnosed while they are organ confined.
In a 2003 study a set of validated criteria that differentiated insignificant from biologically significant disease was completed. The primary objective in developing these criteria was to identify tumors that may not require immediate, or any, intervention, for which surveillance (watchful waiting) would be the management strategy. Further, the authors recommended discretion in that , although they had validated the criteria, they felt compelled to be cautious when considering watchful waiting for the younger patient.
Regardless, there are disadvantages to watchful waiting or active surveillance. Many patients find the idea of forgoing treatment of a cancerous tumor unacceptable, and patient anxiety can be problematic. The treatment options for prostate cancer have been limited to either no intervention or total prostate eradication with radical surgery, radiotherapy, or cryoablation. The absence of an intermediate-level intervention has prompted the development and refinement of treatments aimed at treating the known tumor while sparing healthy prostate tissue, such as targeted, focal cryoablation.
The development of focal cryoablation for prostate cancer follows the path that resulted in a paradigm shift in the management of breast cancer. Breast-conserving surgery (lumpectomy) revolutionized the way that localized breast cancer was treated. It spares the maximum volume of breast tissue to minimize the cosmetic impact while maintaining the efficacy of radical mastectomy for properly selected patients. Focal cryoablation was developed to offer an intermediate level treatment between watchful waiting and total glandular destruction or removal.
The impotence and incontinence that many patients experience after definitive prostate-cancer treatment negatively impact male self-esteem and psyche in a way comparable to the psychological impact of mastectomy on female breast-cancer patients. Similar to lumpectomy, the goal of focal cryoablation is to treat only the region of the tumor while preserving a major portion of the prostate gland to maintain the quality of life.
The results of Dr. Bahn’s most recent studies have shown that focal cryoablation may be more effective than bilateral nerve-sparing prostatectomy in preserving potency in appropriately selected patients. None of the patients developed urinary incontinence and the cancer control rate was excellent.
For more detail, please read the following published papers by Dr. Duke Bahn: