"Male Lumpectomy" for Prostate Cancer

"Male lumpectomy " -- cryotherapy that freezes
tumors but leaves the rest of the prostate intact -- may be the best treatment
choice for many men with early prostate cancer .

The suggestion comes in a presentation to this week's meeting of the Society
of Interventional Radiology by Gary M. Onik, MD, director of the Center for
Safer Prostate Cancer Therapy and professor of radiology at the University of
Central Florida, Orlando.

It's not exactly a new technique. Onik has been exploring its use for more
than a decade in men whose prostate cancer has not spread beyond the prostate
gland. Now he's collected data on 120 men with prostate cancer who underwent
the procedure up to 12 years earlier.

"We've reached a tipping point," Onik says in a news release.
"Treating only the tumor instead of the whole prostate gland is a major and
profound departure from the current thinking about prostate cancer."

In this way, the technique is similar to lumpectomy for breast cancer .
Doctors at first scoffed at the idea that anything short of total mastectomy
would be an appropriate cancer treatment. But with careful patient selection
and better tumor mapping, lumpectomy has become the treatment of choice for
many women with breast cancer.

"I think it is time for men to consider this," Peter Nieh, MD,
director of Emory University's Uro-Oncology Center. Nieh reviewed the Onik
study for WebMD but was not involved in the study.

Nieh says the idea of leaving prostate tissue behind is so different from
standard treatment that it seems "crazy" at first. But it makes sense,
he says, when one considers that there are very few cancers in which the entire
organ is removed.

"The technique is still not mainstream. You'll hear the criticism that
it's not appropriate for all patients," Nieh says. "But when you see
how many patients get radical prostate surgery, and multiply that by the 40%
who would never die of prostate cancer, that is a lot of patients getting
over-treated for what they have."

Onik's data are compelling. Of the 120 patients, 93% are cancer-free an
average of 3.6 years after treatment.

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 Oni 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.

By Daniel DeNoon
Reviewed by Louise Chang
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