- The Washington Times - Monday, October 23, 2006

A procedure nicknamed “male lumpectomy” shows promise as a primary treatment for prostate cancer with a lower risk of impotence and little or no risk of urinary incontinence, according to a report.

Just as a lumpectomy preserves the breasts of breast cancer patients, this new kind of prostate cancer surgery — known as focal cryosurgery — preserves the prostate glands of men with prostate cancer.

With focal cryosurgery, a tumor in the prostate is frozen with a blast of argon gas to destroy it. The process kills the malignant cells but preserves the surrounding healthy tissue.

“We now feel the majority of prostate cancer patients — or 65 [percent] to 75 percent — are candidates for focal cryosurgery, just as most breast cancer patients are candidates for lumpectomies,” rather than full mastectomies, said Dr. Gary Onik, director of surgical imaging at Celebration Health/Florida Hospital in Orlando.

Dr. Onik addressed the 2006 International Conference on Prostate Cancer, which ended Sunday in Reston, on research he has conducted on 95 men whose prostate cancer was treated with focal cryosurgery.

“He’ll take 100 needle biopsies and map them, freezing just those areas,” where cancer cells are found, said Dr. William Lloyd Glover, a clinical professor of urology at Georgetown University School of Medicine, who also spoke at the conference and heard Dr. Onik’s presentation.

Dr. Onik said the patients he studied were followed for an average of 3 years. “We found that 95 percent of them showed no evidence of cancer in PSAs,” Dr. Onik said yesterday in a telephone interview, referring to prostate-specific antigens, determined by tests that measure levels of a protein produced by the cells of the prostate gland. The higher a man’s PSA level, the more likely it is that cancer is present.

“Half of the men we followed were high-risk patients, meaning a lot still had large tumors. So you would not have expected them to do so well,” Dr. Onik added.

Three patients had to be retreated in another area of the prostate gland. “But when they were re-treated, there was no evidence of local cancer. So local treatment was actually 100 percent effective,” he said, adding: “To kill normal tissue, you end up compromising tumor treatment. So we put a tremendous effort into knowing where the cancer is. When we do focal therapy, we’re putting the treatment directly on the tumor.”

What’s more, the Florida physician said, impotence occurred among only 15 percent of the men who received focal cryosurgery. With radiation and other more traditional prostate cancer treatments, he said, the impotence rate is at least 50 percent.

“And incontinence, which is a real problem with other treatments, was zero” in patients who underwent focal cryosurgery, Dr. Onik said. “We’re thrilled and amazed with these results.”

He said a New York urologist who used focal cryosurgery on 25 prostate cancer patients recently published results almost identical to the Florida research team’s.

At the conference, Dr. Glover discussed the success he has had in using cryosurgery — or the freezing of the entire prostate gland — in treating prostate cancer patients.

Of 104 patients treated over four years, he said, only two still had cancer after cryosurgery, and none was incontinent. To help prevent impotence in patients, he said, “I use a nerve-sparing treatment” in which he avoids freezing the nerve to the prostate gland.

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