With 3-D transperineal mapping, a grid placed over the perineum (the area of skin between the rectum and the scrotum) allows an interventional radiologist to accurately map the location of each biopsy core removed. The cores are taken through the skin rather than through the rectum, allowing many more cores to be removedabout 50 compared to 10-12 in a TRUS biopsy. The mapping grid also allows the location of the tumor to be known much more precisely, allowing an interventional radiologist to cryoablate (freeze) only the tumor and not the whole prostate gland.
Controversy surrounds the treatment of prostate cancer, which usually grows slowly and initially remains confined to the prostate gland, said Onik. Growing evidence of overdetection and overtreatment in many men with low-risk tumors has led to a concept in the medical community of "watchful waiting" or observing a man's disease progression prior to initiating treatment. Many patients, however, feel uncomfortable with this strategy and may proceed to radical or aggressive treatment, said Onik. "When men must choose between 'watchful waiting' and high-morbidity whole-gland treatments (like surgery and radiotherapy), a lumpectomy-type treatment, which has so markedly changed the management of breast cancer for women, is a welcome 'middle ground' addition for those with prostate cancer," said Onik.
"Interventional cryoablation for prostate cancer is not experimental. This is a treatment option that doctors should discuss with their patients early on," emphasized Onik. Most people don't realize that you can surgically remove the whole prostate and, in 20 percent of the cases, the cancer can be left (called a positive margin), said Onik, who works in consultation with urologists. Doctors should discuss cryoablation with patients early on, he advised, noting that recently the American Urological Association issued a best practice statement th
|Contact: Maryann Verrillo|
Society of Interventional Radiology