A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance

I focus on prostate cancer, where many patients with low-risk disease still undergo unnecessary treatment. My goal is to develop a more proactive and patient-centered approach to active surveillance. Currently our imaging technologies are needed to identify latency, enable prices, focal tumor eradication, and achieve the optimal balance between oncological control and functional preservation.

Super active surveillance is a safe, effective, and feasible novel treatment street for low-risk prostate cancer. Cryoablation for prostate cancer demonstrates the great potential of the application of cryotherapy and immunotherapy, and the immune effect of cryoablation require more clinical and basics research to explore the specific mechanism. To begin, obtain a patient list that includes patients who have a pathologically-confirmed diagnosis of prostate adenocarcinoma obtained through a prostate system puncture.

Ensure the availability of a cryotherapy system and a real-time image fusion ultrasound system. Prepare a USB flash drive containing 18F-PSMA PET/MR imaging data. Next, choose the appropriate puncture target framework according to the prostate volume and tumor location.

Prepare a V-shaped variable cryoprobe with an adjustable diameter range from 1.5 to five centimeters and two temperature probes. Now, connect the USB flash drive to the integrated ultrasound system. Import the imaging data into the ultrasound fusion software for preoperative planning and target marking.

Complete the full cryoablation preoperative plan. Next, position the patient in the lithotomy position. Administer 0.5 grams of levofloxacin intravenously 30 minutes before surgery.

Insert a three-lumen pure silicone catheter following the infusion. Apply ultrasound and preoperative planning markers from the 18F-PSMA PET/MR images to perform intraoperative registration. Now, insert the variable probe into the identified lesion using the image fusion guidance.

Place a temperature probe in the perineal puncture site anterior to the rectum or in the Denonvilliers fascia. Irrigate the bladder with saline solution through the three-lumen catheter to protect the urethra from frostbite. To start the cryotherapy system, rapidly lower the front end of the cryoprobe to below minus 140 degrees Celsius.

Use ultrasound to monitor the ice ball formation in real time, ensuring its edge extends 0.5 centimeters beyond the preoperative tumor boundary while keeping the rectal temperature probe above zero degrees Celsius. Gradually reduce the freezing power while maintaining the ice ball's coverage area for five minutes. Apply helium gas to rapidly warm the probe tip to above 15 degrees Celsius, and maintain the temperature for five minutes.

Once cryotherapy is complete, remove all probes from the patient. Apply pressure to the puncture site to stop bleeding and cover with a sterile dressing. Observe the urine color in the catheter.

If the urine is clear, do not perform bladder irrigation. If blood is visible, perform bladder irrigation, then transfer the patient to the anesthesia recovery room. Nine patients underwent surgery successfully without any intraoperative complications.

A total of 12 prostate adenocarcinoma lesions were treated using cryoablation across the nine patients. The median postoperative follow-up time was 37 months, with a range of 14 to 61 months.