Chin Joseph L, Lim Darwin, Abdelhady Mazen
Division of Urological Surgery, University of Western Ontario, London, Canada N6A 4G5.
Cancer Control. 2007 Jul;14(3):231-7. doi: 10.1177/107327480701400305.
Cryosurgery has gained popularity as a minimally invasive treatment option for primary and recurrent prostate cancer. Herein we present a review and summary reports on primary cryoablation for prostate cancer and salvage cryoablation following radiation failure.
We reviewed the current published literature in the English language on these topics, along with some historic articles dating back to the 1960s for background and development of the procedure. The material is supplemented by some commentary based on our own 13-year experience with cryoablation for prostate cancer. The review is divided into two sections: primary and salvage cryoablation.
For primary cryoablation, success rates are proportional to the risk categories of the primary cancers. A pretreatment prostate-specific antigen (PSA) <or= 10 ng/mL and an undetectable PSA nadir following cryoablation are associated with a more favorable long-term outcome. Safety profile and quality of life are acceptable in carefully selected patients. Similarly, for salvage cryoablation following radiation failure, patient selection is of paramount importance. The most consistently identified predictive factors for poor cryoablation outcomes were pre-cryoablation PSA > 10 ng/mL and post-cryoablation nadir PSA > 1 ng/mL for salvage procedures. Side effects are more prevalent and serious than with primary cryoablation but for carefully selected patients, the long-term results are favorable.
Patient selection is the key to success with cryoablation, in both the primary and salvage setting. The modality can offer long-term cancer control in carefully selected patient with properly executed techniques.
冷冻手术作为原发性和复发性前列腺癌的一种微创治疗选择已越来越受欢迎。在此，我们对前列腺癌的原发性冷冻消融和放疗失败后的挽救性冷冻消融进行综述并总结报告。
我们回顾了关于这些主题的当前英文发表文献，以及一些可追溯到20世纪60年代的历史文献，以了解该手术的背景和发展。材料还补充了基于我们自身13年前列腺癌冷冻消融经验的一些评论。综述分为两个部分：原发性和挽救性冷冻消融。
对于原发性冷冻消融，成功率与原发性癌症的风险类别成正比。冷冻消融前前列腺特异性抗原（PSA）≤10 ng/mL以及冷冻消融后不可检测到的PSA最低点与更有利的长期结果相关。在精心挑选的患者中，安全性和生活质量是可以接受的。同样，对于放疗失败后的挽救性冷冻消融，患者选择至关重要。对于挽救性手术，最一致确定的冷冻消融结果不佳的预测因素是冷冻消融前PSA>10 ng/mL和冷冻消融后最低点PSA>1 ng/mL。副作用比原发性冷冻消融更普遍和严重，但对于精心挑选的患者，长期结果是良好的。
在原发性和挽救性治疗中，患者选择是冷冻消融成功的关键。对于精心挑选的患者，采用正确实施的技术，这种治疗方式可以实现长期的癌症控制。
