Focal cryosurgery for treatment of primary prostate cancer: the male lumpectomy?

Cryosurgery, in which the whole gland is frozen, has a high rate of impotence, similar to non-nerve sparing radical prostatectomy. In this paper we will present a pilot, study in which 9 patients treated with focal, unilateral nerve sparing cryosurgery were followed for up to 6 years. Methods- Prior to focal nerve sparing cryosurgery all patients were re-biopsied on the side opposite the previous positive biopsy. One neurovascular one spared on the side opposite the positive biopsy. Just prior to the start of freezing a 22 gauge spinal needle was placed into Denonvillier's fascia via a transperineal route and saline were injected to separate the rectum from the prostate. CHT was stopped in all patients postoperatively. PSA's were obtained every 3 months for the first two years and then every 6 months thereafter. Patients were considered to have a stable PSA if they had two consecutive PSA's without a rise. All patients were strongly encouraged to have routine biopsies despite a stable PSA. Results-Between 6/95 and 11/00, 9 patients had focal, nerve sparing cryosurgery. Follow up ranged from 672 months with a mean of 36 months. All patients have stable PSA's at this time. Six patients routinely biopsied had negative biopsies. Potency (defined as erection sufficient to complete intercourse to the satisfaction of the patient) has been maintained in 7 of 9 patients. Conclusion-Focal nerve sparing cryosurgery, in which one NVB is spared, appears to preserve potency in a majority of patients without compromising cancer control. These preliminary results warrant further study.