Anterior Prostate Cancer Cryoablation: A Technique in Prostate Focal Therapy

Abstract

Introduction: Localized clinically significant prostate cancer is highly amenable to curative treatment. However, radical whole gland treatments often result in functional impairment. This has led to interest in gland-sparing treatments such as focal therapy with an aim to preserve sexual and urinary function while eradicating the clinically significant foci of cancer within the prostate. Up to 15% to 20% of prostate cancers are located in the anterior prostate gland. Traditionally these cancers are under detected and present at a later stage when they are large or advanced. However, now with the widespread use of mpMRI, anterior cancers are increasingly detected at lower volumes and earlier stage when they are suitable for zonal ablation while sparing the remainder of the gland. Being anteriorly placed and far from the neurovascular bundles, anterior zone ablation can maximize sexual function outcomes. In this video, we demonstrate our technique for anterior prostate gland cryoablation. Materials and Methods: The patient is placed in the lithotomy position for a transperineal approach to anterior prostate cryoablation. Using variable length cryoprobes, the ice balls are conformed to the anatomical shape of the anterior prostate gland. A urethral warming catheter is used to protect the urethra from cold injury. Temperature probes are placed at the external sphincter and anterior apical margin, the former to ensure that the sphincter remains at a safe temperature and the latter to ensure that lethal temperature is achieved. Two freeze–thaw cycles are performed as per routine cryotherapy practice. Results: We performed two cases of anterior prostate gland cryoablation for tumors identified by mpMRI and confirmed on MRI-TRUS fusion biopsy. Procedure time in each case was 45 minutes. Both cases were performed as day surgeries and were well tolerated. The Foley catheter was removed in 2 weeks and no complications were observed. Conclusions: Anterior prostate cancers represent a subgroup of prostate cancers that are highly amenable to zonal ablation. Being able to spare both neurovascular bundles fulfils the rationale of a gland-sparing approach. No competing financial interests exist. Runtime of video: 4 mins 19 secs