Urology Group, Beatson Institute for Cancer Research, Bearsden, Glasgow, United Kingdom.
PLoS One. 2013 Aug 9;8(8):e69243. doi: 10.1371/journal.pone.0069243. eCollection 2013.
Tissue cryoablation is a potential curative option for solid malignancies, including radiation recurrent prostate cancer (RRPC). Case series of salvage cryotherapy (SCT) in RRPC have reported promising disease free survival (DFS) outcomes and acceptable toxicity profile. While many men receive SCT, no predictive factors for treatment induced side effects are known. The aim of this study is to validate the oncologic outcome of SCT in a large multi-centre patient cohort and to identify potential parameters associated with an increased risk of micturition symptoms.
In this retrospective analysis, we studied 283 consecutive patients with RRPC treated by SCT in three independent U.K. centres (between 2001 and 2011). Two freeze-thaw cycles of transperineal cryotherapy were performed under transrectal ultrasound guidance by a single surgeon in each of the 3 sites. We analysed clinico-pathological factors against tumour response. Functional outcomes were assessed by continence status and IPSS questionnaire. Predictive factors for SCT-induced micturition symptoms were analysed in a sub-group (n=42) of consecutive cases.
We found that nadir post-SCT PSA levels strongly associated with DFS. The DFS rates at 12- and 36-month were 84% and 67% for the ≤ 1 ng/ml group and 56% and 14% for the >1 ng/ml group, respectively (p<0.001). Correlative analysis revealed highly significant association between patients' post-SCT micturition status with prostate gland and iceball lengths following SCT. Finally, in a reduction model, both gland length and maximal length of iceball were highly associated with patients' IPSS outcome (p<0.001).
We report the largest European patient cohort treated with SCT for RRPC. Oncologic outcome guided by nadir PSA of <1 ng/ml is consistent with earlier single-centre series. For the first time, we identified physical parameters to predict micturition symptoms following SCT. Our data will directly assist on-going and future trial design in cryotherapy in prostate cancer.
组织冷冻消融是一种治疗实体恶性肿瘤的潜在方法，包括放射性复发性前列腺癌（RRPC）。RRPC 挽救性冷冻治疗（SCT）的病例系列报告显示出有希望的无疾病生存（DFS）结果和可接受的毒性特征。虽然许多男性接受了 SCT，但尚不知道治疗相关副作用的预测因素。本研究的目的是在大型多中心患者队列中验证 SCT 的肿瘤学结果，并确定与尿失禁症状风险增加相关的潜在参数。
在这项回顾性分析中，我们研究了 283 例在英国三个独立中心（2001 年至 2011 年期间）接受 SCT 治疗的 RRPC 连续患者。在每个 3 个中心，由同一位外科医生在经直肠超声引导下进行两次经会阴冷冻治疗的冻融循环。我们分析了临床病理因素与肿瘤反应的关系。通过控尿状态和 IPSS 问卷评估功能结果。对连续病例的亚组（n=42）分析了 SCT 引起的排尿症状的预测因素。
我们发现，SCT 后 PSA 水平的最低值与 DFS 强烈相关。≤1ng/ml 组的 12 个月和 36 个月 DFS 率分别为 84%和 67%，>1ng/ml 组分别为 56%和 14%（p<0.001）。相关分析显示，SCT 后患者的排尿状况与前列腺和 SCT 后冰球的长度之间存在高度显著的关联。最后，在一个简化模型中，前列腺长度和冰球最大长度都与患者的 IPSS 结果高度相关（p<0.001）。
我们报告了欧洲最大的 SCT 治疗 RRPC 患者队列。以 PSA<1ng/ml 为指导的肿瘤学结果与早期单中心系列一致。我们首次确定了预测 SCT 后排尿症状的物理参数。我们的数据将直接协助正在进行和未来的前列腺癌冷冻治疗试验设计。
