Rationale for a Male Lumpectomy
Gary Onik, MD,
Center for Surgical Advancement
Celebration Health/Florida Advancement
Dr. Gary Onik of Celebration, Florida returned to the podium to deliver a more detailed lecture on what he calls “The Male Lumpectomy” procedure. Onik reviewed the history of the breast lumpectomy. In the early days of breast cancer treatment the standard of care involved removing the entire breast, including chest wall muscles, when a woman was found to have breast cancer. As time went on, the radical mastectomy gave way to mastectomies wherein the breast was removed but the muscles attached to the chest wall were left alone. That procedure ultimately evolved into the lumpectomy largely because earlier detection was more common and doctors began to realize that simply removing the tumor while it was still small and localized produced equally satisfactory results compared to the mastectomy procedure.
Because PCa is often multi-focal (that is it occurs in more than one site within the gland) earlier ideas about treating PCa with any kind of local approach tended to be dismissed as unlikely to be effective. Dr. Onik reported that his search of the prostate pathology literature showed some 20% of PCa were unifocal and 60% were the Index tumor (primary tumor). Another 20% showed focii of PCa sized 5 mm or less. On the basis of these results, Dr. Onik proceeded to develop his biopsy methodology for diagnosing PCa cases and determining their suitability for this “lumpectomy”
In order to determine, to the extent possible, the distribution of tumor focii within the gland, he adopted the concept of the “saturation biopsy.
He calls this procedure the” 3D Mapping Biopsy”. It involves taking a tissue sample every 5 mm in the prostate, transperinealy. To accomplish this many directed biopsies, he uses a type of grid similar to that used when brachytherapy is being performed on the prostate.
A template with holes appropriately distributed through it, is placed over the peritoneum and the doctor proceeds to take multiple samples for pathology. More “standard” prostate biopsies taken today will range between a minimum of 6, and a high of perhaps 20/24 (usually performed in major research centers.
Dr. Onik cited a study by Crawford, et. al. in a 2005 British Journal of Urology in which 95% of “clinically significant” tumors were found via a computer simulation of 106 prostate specimens.
For purposes of this review, we believe that Dr. Onik has introduced a world of new possibilities in the treatment of prostate cancer. If his continuing work with the “male lumpectomy” keeps showing positive results then men facing the decision about which primary therapy they will choose will have to seriously consider this approach along with the other, more ‘traditional’ ones.
Its potential for eliminating some of the very negative side effects of the other primary prostate therapies will have to be given a high weighting.
[ Ed. Note: Because the Editor believes that this approach offers men an alternative worth serious consideration, he plans to write a more detailed review of Dr. Onik’s paper later.]
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