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Primary Zonal High Intensity Focused Ultrasound for Prostate Cancer: Results of a Prospective Phase IIa Feasibility Study

DOI: 10.1155/2014/756189

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Abstract:

Aims. In this study we report our results with storage of cryopreserved semen intended for preservation and subsequent infertility treatment in men with testicular cancer during the last 18 years. Methods. Cryopreserved semen of 523 men with testicular cancer was collected between October 1995 and the end of December 2012. Semen of 34 men (6.5%) was used for fertilization of their partners. They underwent 57 treatment cycles with cryopreserved, fresh, and/or donor sperm. Results. A total of 557 men have decided to freeze their semen before cancer treatment. Seminoma was diagnosed in 283 men (54.1%) and nonseminomatous germ cell tumors in 240 men (45.9%). 34 patients who returned for infertility treatment underwent 46 treatment cycles with cryopreserved sperm. Totally 16 pregnancies were achieved, that is, 34.8% pregnancy rate. Conclusion. The testicular cancer survivors have a good chance of fathering a child by using sperm cryopreserved prior to the oncology treatment, even when it contains only limited number of spermatozoa. 1. Introduction During the last decade, proactive screening for prostate cancer (PCa) in the United States (US) and opportunistic detection in Europe led to a dramatic increase in the incidence of PCa reaching nearly 200.000 new cases per year in the US [1]. Conventional treatment options for organ confined PCa range from active surveillance to whole-gland radical therapy. Active surveillance has the distinct advantage of avoiding overtreatment and treatment related morbidity but carries the risk of silent progression of PCa in up to 35% of cases [2]. It may also induce no treatment related significant anxiety and uncertainty [3]. Radical therapy has the advantage of improving the overall and cancer specific survival in appropriately selected patients [4, 5] but bears significant risk of treatment related functional complications that detrimentally affect the quality of life [5, 6]. Therefore, counseling patients for appropriate, individual treatment strategy remains challenging even for experienced physicians. Consequently, focal therapy has emerged as an alternative option to standard therapies. The goal of this tissue-preserving strategy as defined by the International Task Force on Prostate Cancer and the Focal Lesion Paradigm would be to “selectively ablate(s) known disease and preserve(s) existing functions, with the overall objective of minimizing lifetime morbidity without compromising life expectancy” [7]. A number of focal therapy energies and modalities have commonly been used [8]. Among these therapies, High Intensity

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