Minardi D, Polito M, Galosi A B, Yehia M, Dellabella M, Lugnani F, Muzzonigro G
Istituto di Urologia, Azienda Ospedaliera Umberto I, Università di Ancona.
Arch Ital Urol Androl. 2000 Dec;72(4):270-5.
We have assessed 24 patients consecutively treated with cryosurgery and chosen according to the guidelines of the European Study Group of Urologic Cryosurgeons. Of the 24 patients (average age about 70, range 61-79), all were not considered candidates for radical prostatectomy, 9 (37%) were clinical stage cT2 N0M0, 15 (63%) cT3 N0M0 who had not received any prior treatment, except 1 patient (61 years old) who was treated with TCT and successive recurrence of the disease (cT2). Of the 24 chosen patients, 13 (55%) were over the age of 71, 11 (45%) had important factors of co-morbidity and an elevated risk of surgery (ASA 3). The average PSA was of 19.3 ng/ml (range 2.2-61). Gleason score was 2-5 in 9 cases, 6-7 in 14 and 8-10 in 1 case. In the follow-up, we evaluated serum PSA every 3 months and transrectal ultrasound and the echoguided prostatic biopsies at 6, 12 and 24 months. Post-operative complications included: ecchymosis and edema of external genitals (16/24), fever > 38 degrees C (1/24), sloughing syndrome (6/24), urinary tract infections (10/24) acute urine retention (1/24). In 2 cases, 6 months after treatment, a transrectal resection was carried out. After a follow-up at 6 months, the PSA was 0.4 ng/ml (range 0.1-0.9), in 1 case. In positive core biopsy out of 6 showed neoplastic cells with fibrous tissue; the patient had a PSA of 0.58 ng/ml. At 12 months there were 11 assessable patients. The average PSA was 0.3 ng/ml (range 0.1-0.9). At 24 months there were 4 assessable patients, 1 of 4 showed serum PSA level of 4 ng/ml and cancer in apical biopsy. Erectile dysfunction was assessed on 8 patients affective before surgery: 1 referred to sufficient erections at penetration (1/8, 12.5%). After removal of the catheter, 4 of the 20 patients suffered stress and urge incontinence with the use of 1 pad a day. In 1 case, 18 months from surgery, slight stress incontinence was found (1 pad/day). Cryoablation is an efficient method and is given to slight post-operative morbidity and no intra-operative mortality, also in patients with high risk for open surgery. Indications may be found in patients with the following conditions: older than 72 years, severe co-morbidity and high risk for surgery, neoplasia at high risk of progression, and disease recurrence after radiotherapy. Our case history is at the moment encouraging and a larger number of cases as well as longer follow-up are needed.
我们连续评估了24例接受冷冻手术治疗的患者，这些患者是根据欧洲泌尿外科冷冻外科医生研究小组的指南挑选出来的。在这24例患者中（平均年龄约70岁，范围61 - 79岁），所有患者均不被认为是根治性前列腺切除术的候选者，9例（37%）为临床分期cT2 N0M0，15例（63%）为cT3 N0M0，且这些患者除1例（61岁）接受过经尿道切除术（TCT）且疾病复发（cT2）外，均未接受过任何先前治疗。在这24例入选患者中，13例（55%）年龄超过71岁，11例（45%）有重要的合并症因素且手术风险较高（美国麻醉医师协会分级3级）。平均前列腺特异性抗原（PSA）为19.3 ng/ml（范围2.2 - 61）。Gleason评分2 - 5分的有9例，6 - 7分的有14例，8 - 10分的有1例。在随访过程中，我们每3个月评估血清PSA，在6个月、12个月和24个月时评估经直肠超声以及超声引导下的前列腺活检。术后并发症包括：外生殖器瘀斑和水肿（16/24）、发热>38摄氏度（1/24）、脱屑综合征（6/24）、尿路感染（10/24）、急性尿潴留（1/24）。2例患者在治疗6个月后进行了经直肠切除术。在6个月的随访中，1例患者的PSA为0.4 ng/ml（范围0.1 - 0.9）。6次活检中有阳性结果的活检组织显示肿瘤细胞伴有纤维组织；该患者的PSA为0.58 ng/ml。在12个月时，有11例可评估患者。平均PSA为0.3 ng/ml（范围0.1 - 0.9）。在24个月时，有4例可评估患者，4例中有1例在尖部活检中显示血清PSA水平为4 ng/ml且存在癌症。对8例术前有性功能的患者评估了勃起功能障碍：1例患者表示在插入时有足够的勃起（1/8，12.5%）。拔除导尿管后，20例患者中有4例出现压力性和急迫性尿失禁，每天使用1片尿垫。1例患者在术后18个月发现有轻微的压力性尿失禁（每天1片尿垫）。冷冻消融是一种有效的方法，对于开放手术高风险患者，术后发病率低且无术中死亡率。在以下情况的患者中可能适用：年龄大于72岁、严重合并症且手术风险高、肿瘤进展风险高、放疗后疾病复发。目前我们的病例情况令人鼓舞，需要更多病例以及更长时间的随访。
