Criocirugía (Tercera parte). Revisión de la literatura y nuestra experiencia. (II) / Cryotherapy III, bibliographic review. Our experience (II)

RESUMEN

Resumen

ABSTRACT

OBJECTIVES: To perform a bibliographic review of the main features of cryotherapy as a therapeutic option in the managemente of prostate cancer and to report our initial experience.METHODS: We employed the Endocare Fast-Trac system (Medipro) with 2,4 mm needles implanted in a single maneouvre without rack or transrectal US transducersupport. Two cycles of freezing -thawing were employed, with apex backward movement when necessary. Freezing cycle duration was between 7-10 minutes or more. The Onik maneouvre – injection of saline into the Denonvillier’s space-diminishes the risk of rectal injury and fistula allowing reaching posterior limits of the icaball beyond the prostatic capsule.RESULTS: We treated 20 patients. Follow-up wasbetween 30-36 months. 58% of the patients had unilateral prostate cancer, 42% bilateral. In accordance to the classic definition 9 patients were classified as low risk of extraprostatic disease, 6 medium risk and 5 high risk; using number of positive cores as the criterion for risk 5, 6 and 9 were low, medium and high risk respectively. Per protocol prostate biopsies were performed in 18 patients 6, 12 and 24 months after treatment. Twopatients underwent a second treatment due to persistence of cancer cells in the 6-month biopsy (11%).3-month PSA nadirs after a total of 21 cryo treatments administered were < 0,2 ng/cc in 15 cases (78,9%), < 0,5 ng/cc in 17 (89,4%) and <= 1.0ng/cc in 18 (94,7%); it was over 1 ng/cc in only 5,6% . 30 month PSA for the same cutoff values was 27.8%, 50.0%, 66.6% and 33.3%, respectively.Prostate cancer cells were detected in the 12-month biopsies of 5.5% cases. All 24-month biopsies were negative.COMPLICATIONS We observed scrotal edema, hematoma, perineal pain and constipation which lasted 2-3 weeks. 1 patient suffered injury of the mucosa at the prostatic urethra, which did not result in rectal fistula and was treated with bladder catheter for 3 months. 4 patients had erectile dysfunction before treatment. All others presented erectile dysfunction after treatment; 3 of them (20%) recovered rigidity enough to have intercourse over the 30 month period.No urethral sloughing or acute urinary retention appeared and all patients are continent.CONCLUSIONS: Prostatic cryosurgery is an effective, minimally invasive procedure for the treatment of prostate cancer with very low surgical risk, low morbidity and almost null mortality