Department of Radiology, Mayo Clinic, Rochester, MN.
Urology. 2013 Oct;82(4):870-5. doi: 10.1016/j.urology.2013.06.011. Epub 2013 Aug 1.
To establish the feasibility of magnetic resonance imaging (MRI)-guided cryoablation in patients with previous radical prostatectomy and MRI visualized biopsy-proven local recurrence of prostate adenocarcinoma.
Eighteen postprostatectomy patients (mean 67, 57-78 years) were treated with MRI-guided cryoablation for recurrent prostate carcinoma. Patients were found to have a hyperenhancing nodule using multiparametric MRI with endorectal coil followed by a positive transrectal ultrasound-guided biopsy. Of 18 postsurgical patients, 6 had additional salvage external beam radiation with subsequent recurrence. Under general anesthesia and MRI guidance (wide-bore 1.5T MRI), 2-5 cryotherapy probes were placed in or around the recurrence by transperineal approach and cryoablation performed. The patients were stratified into 2 groups: the initial 9 consecutive patients had cryoprobes placed 1 cm apart with 2 freeze-thaw cycles (group 1), and the subsequent 9 patients had cryoprobes placed 0.5 cm apart with 3 freeze-thaw cycles (group 2).
In group I, the average preprocedure prostate-specific antigen (PSA) was 1.21 ± 1.12 ng/mL, and 1-3 months postprocedure PSA was 0.14 ± 0.11 ng/mL (P <.01). Sixty-seven percent of patients had PSA ≤0.2 ng/mL at 1-3 months follow-up, but only 25% at 4-6 months. No change in impotence or incontinence occurred. In group II, average preprocedure PSA was 2.24 ± 2.71 ng/mL, and 1-3 month postprocedure PSA was 0.08 ± 0.10 ng/mL (P <.05). Eighty-nine percent of patients had PSA ≤0.2 ng/mL at 1-3 months follow-up and at 4-6 months. Complications in group 2 included worsening incontinence in 3 patients.
MRI-guided salvage cryoablation of postradical prostatectomy prostate cancer recurrence is safe and feasible. Both techniques produce early PSA decrease with more lasting PSA results in the more aggressive group II methodology.
探讨 MRI 引导下冷冻消融术治疗根治性前列腺切除术后局部复发性前列腺腺癌的可行性。
对 18 例根治性前列腺切除术后局部复发性前列腺腺癌患者（平均年龄 67 岁，57-78 岁）进行 MRI 引导下冷冻消融术治疗。患者均采用直肠内线圈多参数 MRI 检查发现强化结节，随后经直肠超声引导下活检阳性。18 例术后患者中，6 例在接受额外的挽救性外照射后复发。在全身麻醉和 MRI 引导下（宽孔径 1.5T MRI），经会阴入路置入 2-5 根冷冻探针，行冷冻消融术。将患者分为 2 组：前 9 例患者（组 1）的冷冻探针间隔 1cm，进行 2 个冻融循环；后 9 例患者（组 2）的冷冻探针间隔 0.5cm，进行 3 个冻融循环。
在组 1 中，平均术前前列腺特异性抗原（PSA）为 1.21±1.12ng/ml，术后 1-3 个月 PSA 为 0.14±0.11ng/ml（P<.01）。67%的患者在术后 1-3 个月时 PSA≤0.2ng/ml，但在术后 4-6 个月时仅为 25%。术后勃起功能障碍或尿失禁无变化。在组 2 中，平均术前 PSA 为 2.24±2.71ng/ml，术后 1-3 个月 PSA 为 0.08±0.10ng/ml（P<.05）。89%的患者在术后 1-3 个月和 4-6 个月时 PSA≤0.2ng/ml。组 2 中的并发症包括 3 例患者尿失禁加重。
MRI 引导下根治性前列腺切除术后前列腺癌复发的挽救性冷冻消融术是安全可行的。两种技术均能早期降低 PSA，且在更具侵袭性的组 2 方法中，PSA 持续下降。
