Magnetic resonance imaging-transectal ultrasound image-fusion biopsies accurately characterize the index tumor: correlation with step-sectioned radical prostatectomy specimens in 135 patients.

Background: Prostate biopsies targeted by elastic fusion of magnetic resonance (MR) and three-dimensional (3D) transrectal ultrasound (TRUS) images may allow accurate identification of the index tumor (IT), defined as the lesion with the highest Gleason score or the largest volume or extraprostatic extension.

Objective: To determine the accuracy of MR-TRUS image-fusion biopsy in characterizing ITs, as confirmed by correlation with step-sectioned radical prostatectomy (RP) specimens.

Design, Setting, And Participants: Retrospective analysis of 135 consecutive patients who sequentially underwent pre-biopsy MR, MR-TRUS image-fusion biopsy, and robotic RP at two centers between January 2010 and September 2013.

Effect of targeted biopsy guided by elastic image fusion of MRI with 3D-TRUS on diagnosis of anterior prostate cancer.

Purpose: To evaluate the effect of targeted biopsy (TB) with elastic fused magnetic resonance imaging (MRI) and 3-dimensional transrectal ultrasound (3D-TRUS) guidance in the diagnosis of anterior prostate cancer (APCa).

Material And Method: A retrospective study was performed on patients who underwent TB with elastic fused MRI/3D-TRUS guidance using a 1.5-T MRI with T2- and diffusion-weighted images.

A model for managing erectile dysfunction following prostate cancer treatment.

Purpose Of Review: Radical prostatectomy, regardless of the technology used intraoperatively, induces erectile dysfunction for most men who undergo the procedure. For many men, this proves to be transient. Penile rehabilitation strategies have been developed with the goal of increasing the probability and speed of return of sexual function.

Focal therapy for the treatment of localized prostate cancer: a potential therapeutic paradigm shift awaiting better imaging.

Purpose Of Review: Prostate cancer is a complex disease entity that covers a wide prognosis spectrum. Prostate cancer treatment options do not match this spectrum well. Focal therapy is an active area of research that may allow us to better match treatment to prognosis across the prostate cancer spectrum.

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer.

Background: Localized prostate cancer can be treated several different ways, but head-to-head comparisons of treatments are infrequent. The authors of this report conducted a randomized, unblinded, noninferiority trial to compare cryoablation with external beam radiotherapy in these patients.

Methods: From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were assigned randomly to receive either cryoablation or radiotherapy (122 men in each arm).

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer: quality of life outcomes.

Background: A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease-specific survival. We report on the quality of life (QOL) outcomes for this trial.

Methods: From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy).

Primary cryoablation for Gleason 8, 9, or 10 localized prostate cancer: Biochemical and local control outcomes from the Cryo OnLine database registry.

Introduction And Objective: The increased use of cryoablation as an initial treatment for localized high-grade prostate cancer has been due to many factors including reports that cell kill from exposure to cryogenic temperatures is independent of cellular dedifferentiation and Gleason score. The objective of this study is to report the outcomes of primary cryoablation when used to treat Gleason 8, 9, or 10 localized prostate cancer at a large number of centers.

Materials And Methods: Data from 1608 patients who underwent primary cryoablation at 27 centers were collected using the Cryo OnLine Database (COLD) registry.

High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure.

Objectives: To compare the specificity and sensitivity of different definitions of biochemical failure in patients treated with high-intensity focused ultrasound (HIFU) for prostate cancer, to identify the most accurate predictor of clinical failure after HIFU.

Patients And Methods: Consecutively treated patients who underwent HIFU between October 1997 and July 2006 at two centres (Lyon, France; and Regensburg, Germany) were prospectively maintained within a central database and retrospectively reviewed for this study. Clinical failure was defined as a positive prostate biopsy after treatment, radiographic evidence of lymphatic or bony metastatic disease, or salvage treatment for prostate cancer (surgery, radiation, hormonal therapy or second HIFU).

Single center comparison of laparoscopic cryoablation and CT-guided percutaneous cryoablation for renal tumors.

Background And Purpose: Cryoablation has demonstrated therapeutic effectiveness for selected renal tumors. We compared our perioperative and short-term outcomes of laparoscopic (LAP) v percutaneous (PERC) renal cryoablation.

Patients And Methods: Thirty-four patients (18 men/16 women) underwent a LAP and 26 patients (19 men/7 women) underwent a PERC procedure between September1998 and January 2007.

Salvage prostate cryoablation: initial results from the cryo on-line data registry.

Purpose: We report contemporary outcomes of salvage cryoablation at a large number of centers which have participated in the COLD (Cryo On-Line Data) Registry.

Materials And Methods: A secure online database was developed to collect data for patients undergoing prostate cryoablation. Kaplan-Meier analysis was performed with biochemical failure defined using the American Society of Therapeutic Radiology and Oncology, and the Phoenix definitions.

Whole gland primary prostate cryoablation: initial results from the cryo on-line data registry.

Purpose: We report the largest data set to date to our knowledge regarding outcomes for primary whole gland prostate cryoablation.

Materials And Methods: The COLD (Cryo On-Line Data) Registry consists of case report forms obtaining pretreatment and posttreatment information for patients undergoing whole gland prostate cryoablation. A total of 1,198 patients were stratified into low, intermediate and high risk groups.

Preoperative prediction of unifocal, unilateral, margin-negative, and small volume prostate cancer.

Objectives: Contemporary prostate carcinoma is frequently of small volume and early stage. Subtotal gland ablation by minimally invasive therapies such as cryotherapy demands preoperative prediction of unifocal, unilateral, margin-negative, and small volume (less than 0.5 mL) cancer.

Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results.

The study reported here was undertaken to assess medium short-term efficacy of focal cryoablation as primary therapy for localized prostate cancer and to determine the rate of morbidity in patients who undergo this treatment. Patients were treated with focal cryoablation with argon cryoprobes under ultrasonographic visualization with temperature monitoring. Men who were potent at the time of intervention were encouraged to use a vacuum erectile dysfunction device on a regular basis after treatment.

Cryoablation as primary treatment for localized prostate cancer followed by penile rehabilitation.

Objectives: To determine the medium term efficacy and morbidity of patients who underwent cryoablation as primary therapy for localized prostate cancer followed by a penile rehabilitation regimen.

Methods: Patients were treated with whole gland cryoablation. Those potent at intervention were encouraged to use a vacuum erection device regularly after treatment.

High intensity focused ultrasound for prostate cancer: a review of the scientific foundation, technology and clinical outcomes.

High Intensity Focused Ultrasound (HIFU) is a definitive treatment for localized prostate cancer that is currently utilized most in Europe and Japan but it not yet approved by the FDA for this indication. Within the armamentarium of definitive prostate cancer therapies it is unique as it is truly non-invasive and does not involve incision or excision. The purpose of this paper is to review the scientific foundation of the technology as well as the clinical outcomes of commercially available devices.

Focal prostate cryoablation: initial results show cancer control and potency preservation.

Background: Focal prostate cryoablation is the less-than-complete ablation of the gland with ice. Known tumor is ablated aggressively, whereas contralateral prostate tissue and surrounding structures are spared. This method offers targeted local cancer control aiming at sexual potency and urinary continence preservation in patients whose prostate cancer is believed to be unilateral.

Cryotherapy: clinical end points and their experimental foundations.

More renal tumors are now being found at an early stage. Similarly, the treatment of patients with such small tumors is shifting away from radical nephrectomy toward nephron-sparing extirpative surgery or nonextirpative renal tumor ablation. Of the various techniques used for renal tumor ablation, cryotherapy is the most extensively studied and has the longest reported outcomes.

Cryoablation of small peripheral renal masses: a retrospective analysis.

Renal cryoablation is a minimally invasive, nephron-sparing option that has shown promise in the treatment of patients with solitary small renal lesions suspicious for malignancy. Few large clinical studies have used this promising technology, although intermediate-term data are encouraging. We present a retrospective review and report the outcomes of a large cohort of patients who underwent renal cryotherapy.

Cryoablation and cryolocalization in the management of breast disease.

Cryotechnology is currently used for both treatment and diagnosis of breast disease. Due to the natural analgesic effect of cold, cryoablation is potentially more patient-friendly than other technologies which raise tissue temperature. Freezing produces a predictable volume of necrosis and is easily observed and controlled during treatment.

In treating localized prostate cancer the efficacy of cryoablation is independent of DNA ploidy type.

While the prognostic value of DNA ploidy has been well established for radical prostatectomy, external beam radiation, brachytherapy and androgen deprivation therapy its role as a survival outcome predictor for prostate cancer patients treated with cryoablation has not yet been examined. Anecdotal evidence suggesting that cryoablation may be independent of DNA ploidy type led to the implementation of the current study. Retrospective analysis of data including flow digital cytometry was performed on 447 archival specimens taken from patients who had undergone cryosurgical ablation of primary prostate cancer.

Cryosurgery for breast cancer.

As the majority of breast cancers present as small non-palpable lesions, alternatives for surgical lumpectomy come into consideration. Breast tumor ablation without surgical excision may be a less morbid procedure without sacrificing cancer control. Cryosurgery is one of several ablative options for the treatment of small unifocal breast cancer.

Salvage cryosurgery for recurrent prostate cancer after radiation therapy: a seven-year follow-up.

Cryosurgery of the prostate presents as an efficient therapy following failed radiation therapy. We report on a 7-year retrospective analysis evaluating the morbidity adn biochemical disease-free survival(bDFS) of this therapy. Between 1993 and 2001, 59 patients who had been previously treated with radiation therapy and had rising serum prostate-specific antigen(PSA) values underwent salvage cryoablation of the prostate for localized, histologically proven, recurrent prostate cancer.

Cryotherapy and radiofrequency ablation: pathophysiologic basis and laboratory studies.

Purpose Of Review: There is increasing interest in minimally invasive alternatives to surgery, especially as the natural history of small renal masses appears in the majority to be that of very slow growth. Cryoablation and radiofrequency ablation are two energy-based therapies that can be applied in a minimally invasive manner. We will review the recent clinical and laboratory studies that have formed the scientific foundation of the current clinical protocols and how these protocols may change in light of recent observations.

The current and potential role of cryoablation as a primary therapy for localized prostate cancer.

Targeted cryoablation of the prostate has evolved significantly since its reintroduction in the early 1990s. This evolution stems from engineering advancements, procedural refinement, introduction of temperature monitoring, and greater understanding of cryobiology. Recent publications demonstrate durable efficacy for cryoablation, equivalent to other therapies for low-risk disease and possibly superior for moderate- and high-risk prostate cancer.