Prepelica Kristofer L, Okeke Zephaniah, Murphy Alana, Katz Aaron E
Department of Urology, College of Physicians and Surgeons of Columbia University, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Cancer. 2005 Apr 15;103(8):1625-30. doi: 10.1002/cncr.20944.
The authors report their experience with cryosurgical ablation of the prostate in men with high-risk features for prostate carcinoma who were unwilling to undergo radical surgery or radiation therapy.
Between January 1998 and April 2002, 65 men underwent primary cryosurgery for prostate carcinoma with high-risk features. All patients had biopsy-proven prostate carcinoma without evidence for metastatic disease on magnetic resonance images, computed tomography scans, or radionuclide images of bones. High-risk parameters were defined as either a prostate-specific antigen (PSA) level >/= 10 ng/mL, or a Gleason sum score >/= 8, or both. Patients who had undergone prior surgery, radiation therapy, or cryoablation for prostate carcinoma were excluded from the study. Patients were monitored with physical examination and PSA screening every 3 months and with radiologic imaging when indicated.
The median patient age was 72 years (range, 41-86 years), and t he median follow-up was 35 months (range, 4-77 months). There were 2 patients (3.1%) with rectal pain and incontinence. Durable PSA biochemical disease-free survival was noted in 83.3% of patients according to the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria. A 6-year Kaplan-Meier analysis revealed an 81.7% ASTRO survival probability as well as PSA nadir < 4.0 ng/mL and PSA nadir < 1.0 ng/mL projections of 50% and 35%, respectively. One of 8 postcryosurgery biopsies (12.5%) were positive. No patient had progressed at last follow-up, and the overall survival rate was 100%.
Cryoablation was a feasible treatment option in patients with organ-confined prostate carcinoma who had high-risk features. Longer follow-up will be necessary to determine the effectiveness of this approach.
作者报告了他们对具有前列腺癌高危特征、不愿接受根治性手术或放射治疗的男性进行前列腺冷冻消融术的经验。
1998年1月至2002年4月期间，65名具有高危特征的男性因前列腺癌接受了初次冷冻手术。所有患者经活检证实患有前列腺癌，磁共振成像、计算机断层扫描或骨放射性核素成像均未显示有转移疾病的证据。高危参数定义为前列腺特异性抗原（PSA）水平≥10 ng/mL，或Gleason总分≥8分，或两者兼有。曾因前列腺癌接受过手术、放射治疗或冷冻消融术的患者被排除在研究之外。每3个月对患者进行体格检查和PSA筛查，并根据需要进行影像学检查。
患者的中位年龄为72岁（范围41 - 86岁），中位随访时间为35个月（范围4 - 77个月）。有2例患者（3.1%）出现直肠疼痛和失禁。根据美国放射肿瘤学会（ASTRO）标准，83.3%的患者实现了持久的PSA生化无病生存。6年的Kaplan-Meier分析显示，ASTRO生存概率为81.7%，PSA最低点<4.0 ng/mL和PSA最低点<1.0 ng/mL的预测概率分别为50%和35%。8次冷冻手术后活检中有1次（12.5%）呈阳性。在最后一次随访时，没有患者病情进展，总生存率为100%。
对于具有高危特征的局限性前列腺癌患者，冷冻消融术是一种可行的治疗选择。需要更长时间的随访来确定这种方法的有效性。
