'Male Lumpectomy' for Prostate Cancer
Cryotherapy Freezes Out Tumors, Leaves Rest of Prostate
The most feared side effects of radical prostatectomy and radiation therapy are incontinence and sexual dysfunction. In Onik's study, none of the men became incontinent and 85% of patients remained sexually potent.
Yet, Nieh says, long-term data on focal cryotherapy remains skimpy. That's reflected in the American Urological Association's 2008 "Best Practice Policy Statement" on cryotherapy.
"This procedure may fill a void in the therapeutic options available to men. ... However, current data are insufficient to determine the incidence or consequence of treatment failure," the statement notes.
One advantage to cryotherapy is that if prostate cancer returns, the procedure can be repeated. That's usually not an option after surgery or radiation therapy.
Better Biopsy for Prostate Cancer?
Onik says that one of the keys to successful cryotherapy is a new technique that allows doctors to pinpoint the location of prostate tumors.
That's important for focal cryotherapy, which uses thin needles that inject tumors with freezing gas.
Onik's technique piggybacks on a technique used for brachytherapy, a prostate cancer treatment option in which radioactive beads are implanted in the prostate. Onik places a grid similar to that used in brachytherapy over the perineum -- the area between the scrotum and the anus -- and takes up to 50 tiny needle samples of the prostate.
This technique is less likely to cause infection than the most common prostate biopsy technique, in which doctors approach the prostate through the rectum.
In his conference report, Onik says his trans-perineal biopsies found things that would have been missed by the trans-rectal approach in 70% of patients.
Nieh says the trans-rectal approach is more accurate than Onik makes it sound. But he agrees with Onik that the newer technique is less likely to result in infection. And, given the increasing rate of antibiotic-resistant infections in patients undergoing prostate biopsy, Nieh says this is a major advantage to Onik's approach.