Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA. philippe.spiess@moffi tt.org
BJU Int. 2012 Jul;110(2):217-20. doi: 10.1111/j.1464-410X.2011.10659.x. Epub 2011 Oct 12.
Study Type - Outcomes (cohort). Level of Evidence 2b. What's known on the subject? and What does the study add? The cancer-specific outcomes of salvage cryotherapy for locally recurrent prostate cancer have been well established within contemporary scientific literature. However, very little is known about the outcomes of salvage cryotherapy encompassing health-related quality of life considerations such as continence after treatment. We think the present study is quite novel, as it proposes a new therapeutic endpoint to evaluate the efficacy and outcomes of salvage therapies for locally recurrent prostate cancer, which we have termed the 'bifecta'. In addition, we report that in a large multicentre data registry, such as the COLD Registry, the therapeutic 'bifecta' can be achieved in most patients.
• To evaluate the contemporary outcomes of salvage cryotherapy for locally recurrent prostate cancer using the Cryo On-Line Data (COLD) Registry. • We also evaluate the outcomes of salvage cryotherapy in achieving the therapeutic 'bifecta' consisting of: (i) achieving a post-cryotherapy nadir serum PSA level of <0.6 ng/mL and (ii) no urinary incontinence.
• A prospectively, centrally collected secure online database has been developed of patients undergoing salvage cryoablation for locally recurrent prostate cancer. Of the patients undergoing salvage cryotherapy (in the absence of neoadjuvant hormonal ablative therapy) included within the COLD Registry, complete medical records pertaining to continence status and serial PSA measurements after treatment were available in 183 patients.
• The therapeutic 'bifecta' was achieved in 133 of these patients (72.7%). • Of the patients achieving the 'bifecta', the mean (sd) age at presentation was 71.5 (6.6) years. • Most patients (91%) had a baseline pre-salvage total serum PSA level of <10 ng/mL and a pre-treatment biopsy Gleason score of <8 (85%). • The mean duration of follow-up of patients achieving the 'bifecta' was 36.5 months.
• The therapeutic 'bifecta', a new surrogate benchmark for salvage therapies, can be achieved in most patients undergoing salvage cryotherapy. • Therefore, salvage cryotherapy is a reasonable treatment choice for locally recurrent prostate cancer in appropriately selected patients.
评估使用 Cryo On-Line Data（COLD）Registry 的局部复发性前列腺癌补救性冷冻治疗的当代结果。
我们还评估了补救性冷冻治疗在实现治疗“双效”的结果，该“双效”由以下两个部分组成：（i）实现治疗后血清 PSA 水平<0.6ng/ml 的最低点，以及（ii）无尿失禁。
在这些患者中，133 名患者（72.7%）实现了治疗“双效”。
在实现“双效”的患者中，平均（标准差）年龄为 71.5（6.6）岁。
大多数患者（91%）基线时的总血清 PSA 水平<10ng/ml，治疗前活检的 Gleason 评分<8（85%）。
实现“双效”的患者的平均随访时间为 36.5 个月。
补救性冷冻治疗的治疗“双效”，即一种新的补救治疗替代基准，可以在大多数接受补救性冷冻治疗的患者中实现。
因此，补救性冷冻治疗是局部复发性前列腺癌在适当选择患者中的合理治疗选择。
