Bahn Duke K, Lee Fred, Silverman Paul, Bahn Eric, Badalament Robert, Kumar Anil, Greski Jeffrey, Rewcastle John C
Prostate Institute of America, Community Memorial Hospital, Ventura, CA 93003, USA.
Clin Prostate Cancer. 2003 Sep;2(2):111-4. doi: 10.3816/cgc.2003.n.018.
Cryosurgery of the prostate presents as an efficient therapy following failed radiation therapy. We report on a 7-year retrospective analysis evaluating the morbidity adn biochemical disease-free survival(bDFS) of this therapy. Between 1993 and 2001, 59 patients who had been previously treated with radiation therapy and had rising serum prostate-specific antigen(PSA) values underwent salvage cryoablation of the prostate for localized, histologically proven, recurrent prostate cancer. Serial serum PSA testing was performed, and biopsies were taken at 6, 12, and 24 months, and again at 5 years, and any time the PSA rose above 0.5 ng/mL. Patients were stratified along clinical parameters. The combined postsalvage bDFS rate using a PSA cutoff of 0.5 ng/mL was 59% and 69% with a 1.0 ng/mL PSA cut off. Using a PSA threshold of 0.5 ng/mL as evidence of biochemical recurrence, 61%, 62%, and 50% of patients with <4 ng/mL, 4-10 ng/mL, and > 10 ng/mL PSA, respectively, remain biochemically relapse free at 7 years. A threshold of 1.0 ng/mL yielded a disease-free status of 78%, 74%, and 46% respectively. Patients biopsies showed no evidence of residual or recurrent disease. Improved survival rates and no known latent complications indicate cryosurgery is a promising form of treatment for radiation-resistant prostate cancer. This 7-year analysis shows a promising validation of cryosurgery as an efficacious treatment modality for locally confined T1-T3 prostate cancer following primary radiation therapy failure.
前列腺冷冻手术是放射治疗失败后的一种有效治疗方法。我们报告了一项为期7年的回顾性分析，评估了该治疗方法的发病率及无生化疾病生存率（bDFS）。1993年至2001年期间，59例先前接受过放射治疗且血清前列腺特异性抗原（PSA）值升高的患者，因局部、经组织学证实的复发性前列腺癌接受了挽救性前列腺冷冻消融术。进行了系列血清PSA检测，并在6、12和24个月时以及5年时再次进行活检，且在PSA升至0.5 ng/mL以上的任何时间进行活检。患者根据临床参数进行分层。使用0.5 ng/mL的PSA临界值，挽救后联合bDFS率为59%，使用1.0 ng/mL的PSA临界值时为69%。以0.5 ng/mL的PSA阈值作为生化复发的证据，PSA<4 ng/mL、4 - 10 ng/mL和>10 ng/mL的患者在7年时分别有61%、62%和50%保持无生化复发。1.0 ng/mL的阈值分别产生了78%、74%和46%的无病状态。患者的活检未显示残留或复发性疾病的证据。生存率提高且无已知潜在并发症表明，冷冻手术是治疗耐放射前列腺癌的一种有前景的治疗方式。这项7年的分析显示，冷冻手术作为原发性放射治疗失败后局部局限的T1 - T3前列腺癌的一种有效治疗方式得到了有前景的验证。
