Are Newer Treatments Available?

Prostate removal is recommended for men whose cancer appears to be confined to the prostate gland and has not spread. Unfortunately, in about one-third of men who are undergoing a prostatectomy, surgeons discover during surgery that cancer cells had already spread beyond the prostate.

This has generated research on a variety of surgical techniques that might destroy prostate tumor cells not only within the prostate gland but beyond its borders as well. The result is an experimental technique that can be used for men with prostate cancer, even those with advanced stages of cancer.

The technique, called percutaneous prostate cryoablation, causes destruction of the prostate gland by forming an iceball that envelops the cancerous tissues and cells in and immediately surrounding the gland.

There are two major steps in preparing for this cryosurgery procedure:

• A biopsy of the prostate gland guided by a transrectal ultrasound probe to determine the full extent of the cancer

• Androgen ablation therapy using the hormone testosterone to shrink the prostate gland, in order to ensure the complete destruction of tissue throughout the gland

The basic procedure for percutaneous prostate cryoablation involves the following:

• The procedure involves general anesthesia (in which the man is asleep for surgery) or spinal anesthesia (in which the man's body is numbed from the waist down).

• The cryoprobes used to form the iceball within the prostate gland are placed through the perineum and into the prostate gland.

• After the appropriate placement of five or six cryoprobes under the guidance of a transrectal ultrasound probe, freezing is carried out.

• Thermosensors are implanted to monitor the freezing temperatures to ensure appropriate tissue destruction and to insure freezing of other areas.

Percutaneous prostate cryoablation has the following advantages over radical prostatectomy:

• Blood loss during surgery is small and a blood transfusion is unnecessary.

• There is no recorded mortality rate associated with this technique.

• The rate of incontinence is lower than that associated with radical prostatectomy.

• The procedure can be used to successfully treat prostate cancer even when cancer cells are found to have spread.

The following complications are associated with cryosurgery:

• The development, in less than one percent of men, of an abnormal communication between the urethra and the rectum as a result of inadvertently freezing the rectal wall, which is located close to the base of the prostate gland.

• The development of impotence in approximately 50 percent of the men treated, as a consequence of intentionally freezing the bundles of nerves and blood vessels responsible for erection because of the presence of cancer cells in the bundles.

Percutaneous prostate cryoablation is still in its infancy as a surgical technique. Because it is a difficult and complex procedure, it is not performed by all surgeons and is not available at all hospitals. Improvements in percutaneous prostate cryoablation need to be made, but some experts believe this procedure may well be the wave of the future.