OBJECTIVES: To describe our step-by-step free-hands technique for focal cryoablation (FC) of prostate cancer (PCa).
MATERIAL AND METHODS: FC was offered to patients with biopsy-proven unilateral low- to intermediate-risk PCa with consent after detailed discussion of limitations and benefits of FC. The procedure was performed transperineally, using free-hands (without external grid template) technique under real time bi-plane transrectal ultrasound (TRUS)-guidance using an argon/helium-gas-based third generation Cryoablation system. Follow up consisted of validated questionnaires; physical examination; PSA; multiparametric TRUS and/or MRI and mandatory biopsy.
RESULTS: Important steps to achieve safety, satisfactory oncological and functional outcomes included: Patient selection, including TRUS/MRI fusion target biopsy. Thermocouples (TC) and cryoprobes (CP) placement with free-hands technique allows delivery in unrestricted angulations according to the prostatic contour, course of neurovascular bundle, and rectal wall angle. Free-hands bi-plane TRUS probe manipulation to facilitate real-time monitoring of anatomic landmarks in ideal angle of the image plane. To achieve lethal temperature in the known cancer area while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall by continuous intraoperative control of: (1) TC temperatures; (2) real-time TRUS monitoring of ice-ball size; (3) energy delivered; and (4) use of warming urethral catheter.
CONCLUSION: We detailed the step-by-step focal cryoablation for prostate cancer using the free-hands technique. This technique facilitates effective delivery of cryoprobes as well as intra-operative real-time quick manipulation of TRUS probe.
Written by:
de Castro Abreu AL, Bahn D, Chopra S, Leslie S, Matsugasumi T, Gill IS, Ukimura O. Are you the author?
USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Reference: BJU Int. 2014 May 6. Epub ahead of print.
doi: 10.1111/bju.12795
PubMed Abstract
PMID: 24802231
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