Journal List > Kosin Med J > v.29(2) > 1057021

Choi: Nerve-Sparing Cryoablation for the Treatment of Primary Prostate Cancer: the Preliminary Report



To present a pilot study of nerve-sparing cryoablation for the treatment of primary prostate cancer. Materials and Methods: Between 2008 and 2011, 9 patients underwent nerve-sparing cryoablation (unilateral 5, bilateral 4 patients). One neurovascular bundle (NVB) was spared on the side opposite the positive biopsy, and two NVBs were spared when indicated and possible. Just before the start of freezing, a 22-gauge spinal needle was placed into Denonvilliers fascia using a transperineal route, and normal saline was injected to separate the rectum from the prostate. The prostate-specific antigen (PSA) level was sampled every 3 months for the first 2 years and then every 6 months thereafter. Patients were considered to have a stable PSA if they had two consecutive PSA measurements without a rise.


The follow-up was 4ᄋ-months (19-66 months). All patients had stable PSA levels at last follow-up. Potency (defined as an erection sufficient to complete intercourse to the satisfaction of the patient) was maintained in 4 of 9 patients, 5 were potent with phosphodiesterase 5 inhibitors or intracavernosal injection. Conclusions: Nerve-sparing cryoablation, in which one or two neurovascular bundle is spared, showed the possibility of preserving potency in most patients without compromising cancer control. These preliminary results warrant further study.


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Fig. 1.
A schematic of the cryoprobe and warming probe placement for A,
Table 1.
Patient characteristics
Age (yr) Gleason Score Preop.PSA (ng/mL) Positive Cores(n) Stage Preop.TURP/ HOLEP Area frozen Follow-up (mo) Postop.PSA (ng/mL) PSA stable Change/Potency
68 7 16.06 1 T1c No Unilateral 71 0.07 Yes Potent with PDE5I
61 6 9.78 1 T1c No Unilateral 68 1.0 Yes Potent
58 4 10.44 4 T2a No Bilateral 68 0.84 Yes Potent
58 7 5.7 2 T2a No Unilateral 36 0.2 Yes Potent with ICI
52 5 3.70 1 T1c No Unilateral 39 0.17 Yes Potent with ICI
58 7 3.2 1 T1c Yes Bilateral 21 0.04 Yes Potent with ICI
65 7 3.00 1 T1c Yes Bilateral 21 0.09 Yes Potent with ICI
58 6 4.56 4 T1c No Unilateral 20 0.013 Yes Potent
46 6 9.33 2 T2a No Bilateral 19 0.4 Yes Potent

PSA=prostate specific antigen, Stage=clinical Τ stage

TURP=transurethral resection of the prostate, HOLEP=holmium laser enucleation of the prosate,

PDE5l=phosphodiesterase 5 inhibi tors, ICI=intracavernsal injection.

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