Ellis David S, Manny Theodore B, Rewcastle John C
Urology Associates of North Texas, Arlington, Texas 76012, USA.
Urology. 2007 Feb;69(2):306-10. doi: 10.1016/j.urology.2006.10.024.
To determine the medium term efficacy and morbidity of patients who underwent cryoablation as primary therapy for localized prostate cancer followed by a penile rehabilitation regimen.
Patients were treated with whole gland cryoablation. Those potent at intervention were encouraged to use a vacuum erection device regularly after treatment. Incontinence was defined as any leakage of urine. Potency was defined as the ability to achieve an erection sufficient to complete intercourse with or without oral pharmaceutical agents. Biochemical failure was defined as three successive rises in prostate-specific antigen, with a final value greater than 1.0 ng/mL.
A total of 416 consecutive patients were treated. The mean patient age was 69.4 years, mean prostate-specific antigen level was 8.7 ng/mL, median Gleason score was 6, and median stage was T1c. The mean follow-up of the entire population was 20.4 +/- 14.7 months. Of those continent before treatment, 4.0% were incontinent at 6 months but only 2 (0.6%) used any absorbent pads. Kaplan-Meier analysis demonstrated progressive recovery of sexual function of preoperatively potent men, with 41.4% +/- 4.3% and 51.3% +/- 5.9% potent 1 and 4 years after treatment, respectively. No patients had rectal fistula. The actuarial probability of remaining biochemically disease free at 4 years was 79.6% +/- 2.4%, with a mean time to failure of 4.2 months. After therapy, 168 patients underwent biopsy; 17 had positive findings (10.1%). The positive biopsy rate for the entire population was 4.1% (17 of 416).
The results of our study have indicated that cryoablation as a primary treatment of localized prostate cancer is effective with acceptable morbidity. The use of a penile rehabilitation regimen after treatment appeared to substantially increase postcryoablation potency.
确定接受冷冻消融作为局限性前列腺癌主要治疗方法并随后采用阴茎康复方案的患者的中期疗效和发病率。
对患者进行全腺冷冻消融治疗。鼓励治疗时仍有性功能的患者在治疗后定期使用真空勃起装置。尿失禁定义为任何尿液泄漏。性功能定义为无论是否使用口服药物制剂都能勃起至足以完成性交的能力。生化失败定义为前列腺特异性抗原连续三次升高，最终值大于1.0 ng/mL。
共连续治疗416例患者。患者平均年龄为69.4岁，平均前列腺特异性抗原水平为8.7 ng/mL， Gleason评分中位数为6，分期中位数为T1c。全体患者的平均随访时间为20.4±14.7个月。治疗前控尿的患者中，4.0%在6个月时出现尿失禁，但仅2例（0.6%）使用了任何吸收性尿垫。Kaplan-Meier分析显示术前有性功能的男性性功能逐渐恢复，治疗后1年和4年分别有41.4%±4.3%和51.3%±5.9%恢复性功能。无患者发生直肠瘘。4年时无生化疾病的精算概率为79.6%±2.4%，平均失败时间为4.2个月。治疗后，168例患者接受活检；17例有阳性结果（10.1%）。全体患者的活检阳性率为4.1%（416例中的17例）。
我们的研究结果表明，冷冻消融作为局限性前列腺癌的主要治疗方法是有效的，发病率可接受。治疗后采用阴茎康复方案似乎可显著提高冷冻消融后的性功能。
