Long J P, Bahn D, Lee F, Shinohara K, Chinn D O, Macaluso J N
Department of Urology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA
Urology. 2001 Mar;57(3):518-23. doi: 10.1016/s0090-4295(00)01060-8.
To define the potential role of cryosurgical ablation of the prostate (CSAP) as a treatment option for patients with localized prostate carcinoma (PCA), we performed a retrospective outcomes analysis of a large database of patients undergoing CSAP constructed from five institutions and compared this with matching outcomes from contemporary reports of patient outcomes after radiotherapy.
A total of 975 patients who underwent CSAP as primary therapy from January 1993 to January 1998 with sufficient outcomes data available were identified. Patients were stratified into three groups on the basis of their clinical features. Biochemical-free survival (BFS), post-CSAP biopsy results, and post-CSAP morbidities were calculated and recorded.
The median follow-up for all patients was 24 months. The percentages of patients in the low, medium, and high-risk groups were 25%, 34%, and 41%, respectively. For prostate-specific antigen thresholds of less than 0.5 and less than 1.0 ng/mL, the 5-year actuarial BFS ranged from 36% to 61% and 45% to 76%, respectively, depending on the risk category. Overall, the positive biopsy rate was 18%. Morbidities included impotence in 93%, incontinence in 7.5%, rectourethral fistula in 0.5%, and transurethral resection of the prostate in 13% of patients (10% approved warming catheters versus 40% nonapproved).
For each risk group, the 5-year BFS and positive biopsy rate after CSAP was comparable to matching outcomes reported after radiotherapy. Morbidities also seemed comparable, with impotence rates higher and rectal injury rates lower after CSAP than after radiotherapy. These data indicate that CSAP can be performed with low morbidity and can produce cancer-related results comparable to those reported for patients undergoing radiotherapy.
为明确前列腺冷冻消融术（CSAP）作为局限性前列腺癌（PCA）患者治疗选择的潜在作用，我们对来自五个机构构建的接受CSAP治疗患者的大型数据库进行了回顾性结局分析，并将其与当代放疗后患者结局报告中的匹配结局进行比较。
确定了1993年1月至1998年1月期间接受CSAP作为主要治疗且有足够结局数据的975例患者。根据临床特征将患者分为三组。计算并记录无生化复发生存率（BFS）、CSAP后活检结果及CSAP后并发症。
所有患者的中位随访时间为24个月。低、中、高危组患者的百分比分别为25%、34%和41%。对于前列腺特异性抗原阈值小于0.5和小于1.0 ng/mL，5年精算BFS根据风险类别分别为36%至61%和45%至76%。总体而言，活检阳性率为18%。并发症包括93%的患者出现阳痿，7.5%的患者出现尿失禁，0.5%的患者出现直肠尿道瘘，13%的患者接受了经尿道前列腺切除术（10%使用批准的加温导管，40%未使用）。
对于每个风险组，CSAP后的5年BFS和活检阳性率与放疗后报告的匹配结局相当。并发症似乎也相当，CSAP后阳痿发生率高于放疗，直肠损伤发生率低于放疗。这些数据表明，CSAP可以在低并发症的情况下进行，并且可以产生与放疗患者报告的癌症相关结果相当的结果。
