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| |  RSNA: Cyrosurgery Preserves Potency in Prostate Cancer Pilot Study By Ed Susman Special to DG News CHICAGO, IL -- November 27, 2001 -- Preliminary results indicate that a "middle ground" procedure in treating prostate cancer appears to kill the malignancy without long-term loss of potency. In a pilot study involving nine patients with high risk prostate cancer, seven of the men have been able to maintain potency following the focused cryosurgery in which doctors attack only the cancerous lesions, leaving the gland intact. "When men are diagnosed with prostate cancer, often they have to decide between ‘watchful waiting’ or choosing one of several treatments, all of which often cause side effects such as impotence, incontinence and bowel problems" said Gary Onik, MD, director of surgical imaging at Florida Hospital Celebration Health, in Celebration, Florida. In his newly developed procedure, up to five ultrasound-guided cryoprobes are inserted into the prostate, which is then frozen, thawed and re-frozen, killing the cells.In a presentation at the 87th scientific assembly and annual meeting of the Radiological Society of North America, in Chicago, Illinois, Dr. Onik said the procedure offers patients a middle ground of treatment with reduced complications. He said patients were considered for the treatment if biopsies confirmed that cancer was confined to one prostate lobe. "Pathologic literature indicates that 35 percent of prostate cancers are solitary and unilateral," he said, which suggest a large number of the nearly 200,000 men who are diagnosed with prostate cancer each year in the United States would be potential candidates for the procedure. By not damaging, manipulating or disturbing any of the nerves controlling erection, his patients appeared to recover sexual function quickly-in one case within five days post-surgery. In standard nerve-sparing surgeries, Dr. Onik said it can take up to a year for potency to return, and it is expected in 50 percent or less of patients who undergo the procedure. He said the results of his study-in which cancer has not recurred in any of the patients for as long as six years-have prompted a large-scale, prospective comparative clinical trial comparing focused cryosurgery and nerve-sparing prostatectomy. While not a double-blind trial, Dr. Onik said the patients will be well-matched to determine recurrence rates and treatment side effects. He said his study received no outside funding, however, he is a consultant for Endocare Inc. of Irvine, Calif., which manufactures some of the equipment used in the procedure and will support the multicenter trial. Dr. Fred Lee Jr., associate professor of radiology at the University of Wisconsin in Madison, Wisconsin, said, "Focused cryosurgery has not been thoroughly evaluated yet. We are concerned that prostate cancer is a multi-focal disease and that the disease might appear in other lobes of the prostate." Dr. Lee said the work being done by Dr. Onik is encouraging in that there have not been recurrences and "multiple clinically significant tumors aren’t popping up." He also said the multicenter trial would also show if the procedure can be performed successfully by several physicians rather than just being the trademark of the one doctor who invented and developed the procedure. Dr. Onik said that the procedure can be done as an outpatient procedure and its total costs could be expected to be considerably less than other forms of surgery, brachytherapy, external radiation beam therapy or total prostate ablation cryosurgery.
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