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"The
Male Lumpectomy"- Introduction
The
use of breast sparing surgery i.e. "lumpectomy"
to treat breast cancer has revolutionized the local control
of that disease. Lumpectomy showed that the quality of
life of a patient can be preserved, with excellent cancer
control. Prostate cancer in men raises many of the same
issues that breast cancer does in woman. Complications
of prostate cancer treatment, including impotence and
incontinence, affect the male self image and psyche no
less than the loss of a breast does a woman. Current management
of prostate cancer offers no viable middle ground between
"watchful waiting" and an aggressive whole gland
treatment such as radical prostatectomy. Our results,
and now those of other investigators indicate that a "lumpectomy"
approach for men is a viable treatment for prostate cancer.
The questions that need to be answered about such an approach
include:
- Does
the literature on prostate pathology support a focal
approach to treating prostate cancer?
The main theoretical objection to a lumpectomy approach
to prostate cancer is the argument that prostate cancer
often occurs in multiple areas of the prostate. As in
breast cancer however prostate cancer is a spectrum
of diseases some of which may be amenable to lumpectomy
and others that may not. From the current pathology
literature up to 70% of patients may be good candidates
for a prostate cancer lumpectomy.
- Is
whole gland cryoablation a safe and effective treatment
for prostate cancer?
Since the anatomy of the prostate gland does not make
it amenable to partial removal or surgical lumpectomy,
tumor destruction by another method needs to be used
to accomplish a lumpectomy in a male. Cryoablation has
a long history of effective tumor treatment and has
been shown to be an effective and safe alternative in
treating the whole gland with prostate cancer. Over
6 years ago prostate cryoablation was approved by Medicare
as a treatment for primary prostate cancer (removing
from it the investigational category). Long term 5 and
7 year data published by Drs. Donnelly and Bahn confirms
cryoablation as a treatment competitive with and in
some cases superior to, both surgery and radiation in
treating prostate cancer.
- Do
the initial results of "male lumpectomy" for
prostate cancers indicate good cancer control and complications
such as impotence and incontinence reduced?
The initial results of a male lumpectomy using cryoablation
have been published in peer reviewed journals and been
presented at major medical meetings. A recent meeting
held at Celebration Health, in which many of prostate
cancer expert's in the country participated, came to
the consensus that a "Male Lumpectomy" or
in other words a "focal" management approach
to prostate cancer was a viable and reasonable treatment
option. The proceedings of this meeting, along with
the consensus statement, will appear in the urology
literature in the near future.
The results presented at this meeting showed that the
cancer control rate in patients followed up to 10 years
is a high as 95% and the potency rate is approximately
85%. In patients without previous surgery or radiation,
the incontinence rate was uniformly zero.
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