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Medical Author:

Kevin C. Zorn, MD, FRCSC, FACS

Kevin C. Zorn, MD, FRCSC, FACS

Dr. Kevin Zorn is a dual-board-certified (US and Canada), minimally-invasive uro-oncology, fellowship trained urologist at the University of Chicago. His main focus of clinical and scientific interest is in the surgical treatment of renal and prostate cancer. He is also an expert in performing surgery with the DaVinci Surgical Robotic System to manage localized prostate cancer and small renal masses. Dr. Zorn studied medicine and urology at McGill University in Montréal.

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Coauthor:

Pierre-Alain Hueber, MD, PhD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Besides radical prostatectomy, external beam radiation and/or brachytherapy, cryosurgical ablation of the prostate and high-intensity focused ultrasound (HIFU) have emerged as alternative therapeutic options in patients with clinically-localized prostate cancer.

Cryotherapy and high-intensity focused ultrasound (HIFU) have been used to destroy tissue, either by freezing or by generating local thermal energy. These techniques can be applied focally, sub-totally, or to the entire prostate gland. However, the role of these techniques remains uncertain. Potential advantages in men with localized disease include the ability to destroy cancer cells using a relatively noninvasive procedure. As such, these procedures are associated with minimal blood loss and pain. There is also faster post-treatment convalescence.

Cryotherapy

This technique involves inserting a probe through a small skin incision and freezing areas of cancer in the prostate.

• This therapy is reserved for cancer localized within the prostate as well as for men who are unable to withstand the conventional therapies such as surgery or radiation.
• The probe is guided to areas of cancer by using TRUS. Cancerous tissue appears on the ultrasound and allows the surgeon to monitor therapy and limit damage to normal prostate tissue.
• There are several advantages to using this procedure over surgery and radiation therapy. There is less blood loss, a shorter hospital stay and recovery time, and less pain than with conventional surgery.
• The long-term effectiveness of this procedure is unknown because it is a newer treatment.
• The role of cryotherapy in the management of localized disease remains uncertain. Even among men with low-risk disease, it is not yet clear that results with cryotherapy are equal to those with radical prostatectomy or radiotherapy.

HIFU

• HIFU (high-intensity focused ultrasound) was first developed as a treatment for benign prostatic hyperplasia (BPH) and is now also being used as a procedure for the killing of prostate cancer cells. This procedure utilizes transrectal ultrasound that is highly focused into a small area, creating intense heat of 80° C to 100° C, which is lethal to prostate cancer tissue.
• The published clinical experience with HIFU for this application is limited and the procedure is not yet approved by the FDA for use in the U.S.

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