Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Radical Nephrectomy for pT1a Renal Masses May be Associated With Decreased Overall Survival Compared With Partial Nephrectomy

https://www.europeanurology.com/article/S0302-2838(13)00557-5/pdf/the-role-of-focal-therapy-in-the-management-of-localised-prostate-cancer-a-systematic-review

The role of focal therapy in the management of localised prostate cancer: a systematic review

https://www.europeanurology.com/article/S0302-2838(16)30512-7/pdf/new-and-established-technology-in-focal-ablation-of-the-prostate-a-systematic-review

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review

Among men who experience prostate-specific antigen (PSA) failure after external beam radiation or brachytherapy (RT), many will harbor occult micrometastases; however, a significant minority will have a true local-only failure and, thus, potentially may benefit from a salvage local therapy. Those most likely to have a local-only failure initially have low-risk disease (PSA 3 years, PSA doubling time > 12 months, negative bone scan and pelvic imaging, and positive rebiopsy. In addition, men with presalvage PSA levels > 10 ng/mL, presalvage T3/T4 disease, or presalvage Gleason scores > or =7 on a rebiopsy sample without significant RT effects are unlikely to be cured by salvage local therapy. Based on a review of all series of post-RT salvage prostatectomy, cryosurgery, and brachytherapy published in English since 1990, morbidity can be substantial. Although urinary incontinence appeared to be greater after salvage prostatectomy (41%) or cryosurgery (36%) than after brachytherapy (6%), patients who received salvage brachytherapy faced a 17% risk of grade 3 or 4 genitourinary complications and a fistula risk that averaged 3.4% across all series. From this review, the authors concluded that prospective randomized studies are needed to determine the relative efficacy of the 3 major local salvage modalities and that additional research is needed to identify factors associated with an increased risk of significant complications to improve patient selection and to augment the benefit/risk ratio associated with attempts to cure local-only recurrences after radiation therapy.

/pdf/patient-selection-cancer-control-and-complications-after-26zt11ojgj.pdf

Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure : A systematic review of the literature

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. Patients and Methods: Patients who had a strong desire for preservation of sexual function and continence were informed of focal prostate cryoablation as an investigational treatment option for clinically organ-confined, unilateral tumor identified by color Doppler ultrasonography and confirmed by targeted and systematic biopsy. Only stage, not preoperative serum prostate specific antigen concentration (PSA) or tumor differentiation, was considered a potential contraindication. Thirty-one men with a mean age of 63 years underwent the procedure. Follow-up consisted of PSA measurement every 3 months for 1 year and every 6 months...

https://pioa.org/wp-content/uploads/2010/05/Bahn-J-Endo-Focal.pdf

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

https://pioa.org/wp-content/uploads/2010/05/Bahn-Salvage-Paper.pdf

Salvage Cryosurgery for Recurrent Prostate Cancer After Radiation Therapy: A Seven-Year Follow-up

Objectives

To present the oncological and functional outcomes of salvage focal (SFC) and salvage total (STC) cryoablation for recurrent prostate cancer (PCa) after failed primary radiotherapy




Patients and Methods

From March 2003 to August 2010, 50 men with biopsy-proven unilateral (n = 25) or bilateral (n = 25) radio-recurrent PCa underwent SFC or STC, respectively
Patients were assessed after treatment by prostate-specific antigen (PSA) testing, transrectal ultrasonography, biopsy and questionnaires Biochemical failure (BF) was defined using the Phoenix criteria (PSA nadir + 2 mg/mL)
Data were prospectively collected and retrospectively analysed




Results

The median pre-cryoablation PSA level and Gleason score were, respectively, 28 ng/mL and 7 for SFC, and 39 ng/mL and 7 for STC The median follow-up was 31 and 53 months (P = 0004) for SFC and STC, respectively
Oncological outcomes were as follows: no patient died; one patient who underwent STC developed bone metastases; eight patients who underwent SFC and three who underwent STC had BF and the 5-year BF-free survival rates were 54 and 86%, respectively In those patients without BF, the mean PSA decreased by 86% for SFC and 90% for STC within the first year and remained stable
Functional outcomes were as follows: new onset urinary incontinence occurred in three (13%) patients in the STC group, whereas no patient in the SFC group developed incontinence (P = 010); Two of seven patients in the SFC group retained postoperative potency, but none of the four potent patients in the STC group recovered potency postoperatively (P = 048); one (4%) patient in the STC group developed a recto-urethral fistula, but none occurred in the SFC group (P = 048)




Conclusions

SFC and STC are feasible and safe with acceptable mid-term oncological outcomes For carefully selected patients, SFC is an option that could be associated with lower treatment-related morbidity compared with STC
Although longer follow-up and more patient numbers are needed, our initial oncological and functional outcomes of SFC and STC are encouraging

Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy.

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. Five-year biochemical disease free survivals (bDFS) (defined as PSA thresholds of 0.5 and 1.0 ng/ml) were determined with Kaplan-Meier analysis. Patients were grouped according to DNA ploidy types then stratified by Gleason grade, risk group, pre-surgical PSA level, and disease stage. Mean and median age of the cohort was 65 and 64.6 years. Mean follow-up was 65.7 months. The DNA ploidy status of the population was found to be 59% diploid, 13% tetraploid, and 28% aneuploid. Using PSA < 1.0 ng/ml criterion, the bDFS rates for diploid, tetraploid, and aneuploid were 78%, 75%, and 79% respectively. The bDFS rates using a PSA < 0.5 ng/ml criterion were 67%, 59%, and 69% for diploid, tetraploid, and aneuploid groups. No significant outcome differences were found in stratified analysis. This investigation demonstrates that the efficacy of cryoablation is independent of DNA ploidy type.

https://journals.sagepub.com/doi/pdf/10.1177/153303460400300303

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

Current treatment options for men with early localized prostate cancer are either some form of radical therapy or active surveillance. Radical therapy is usually associated with significant adverse effects that might jeopardize a man's quality of life. Some observers believe that PSA screening has resulted in the over diagnosis and over treatment of prostate cancer. Many men are being diagnosed with an early stage, small volume, unifocal or unilateral prostate cancer but are reluctant to accept watchful waiting or active surveillance. Focal cryoablation is the less than complete ablation of the gland with ice. Based on review of the limited amount of material available in the current literature, focal cryoablation can provide acceptable cancer control while preserving sexual potency and urinary continence. Focal cryoablation may fill a void in the therapeutic options available to patients with unifocal or unilateral prostate cancer who have a strong desire to maintain their quality of life.

https://pioa.org/wp-content/uploads/2010/05/Focal-Scientific-Paper.pdf

Focal Cryoablation of Prostate: A Review

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