Ginsburg Kevin B, Elshafei Ahmed, Yu Changhong, Jones J Stephen, Cher Michael L
Department of Urology, Wayne State University School of Medicine, Detroit, Michigan.
Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Prostate. 2017 Oct;77(14):1446-1450. doi: 10.1002/pros.23406. Epub 2017 Aug 29.
To investigate the ability of salvage cryoablation of the prostate (SCAP) to delay the need for androgen deprivation therapy (ADT) in local recurrence after radiation therapy to the prostate using the Cryo-On-Line Database (COLD) registry.
The COLD registry is comprised of a combination of retrospectively and prospectively collected data on patients undergoing primary and SCAP. Patients with local recurrence after radiation therapy were identified. Kaplan-Meier analysis was used to calculate ADT-free survival.
We identified 898 patients that have undergone SCAP in the COLD registry. Overall, the calculated 5-year ADT-free survival probability was 0.713. When stratified by D'Amico risk group, 264 high-risk patients (71.9%), 234 intermediate-risk (86.7%),and 228 low-risk (87.7%) were free of ADT post-SCAP. This correlates with a 5-year ADT-free survival of 60.7, 73.9, and 82.4%, respectively. Patients with post-SCAP PSA nadir of <0.2 ng/mL had a 5 year ADT-free survival of 87.1% compared to 48.7% with a PSA nadir ≥0.2 ng/mL. Pre-operative ADT use or full versus partial gland SCAP did not have an effect on ADT use post-operatively. In 118 (55.4%) of patients with post-operative biochemical recurrence, ADT was not used.
For patients with local recurrence after radiation, SCAP is an option that provides a high chance of avoiding or delaying ADT. The potential to delay ADT and its associated side effects should be a part of counseling sessions with the patient when discussing treatment options for locally recurrent prostate cancer after radiation. Avoidance of ADT is more clinically relevant than PSA elevation.
利用冷冻在线数据库（COLD）登记系统，研究挽救性前列腺冷冻消融术（SCAP）延缓前列腺放疗后局部复发患者雄激素剥夺治疗（ADT）需求的能力。
COLD登记系统包含回顾性和前瞻性收集的接受初次及挽救性前列腺冷冻消融术患者的数据。确定放疗后局部复发的患者。采用Kaplan-Meier分析计算无ADT生存期。
我们在COLD登记系统中确定了898例接受SCAP的患者。总体而言，计算得出的5年无ADT生存概率为0.713。按达米科风险组分层时，264例高危患者（71.9%）、234例中危患者（86.7%）和228例低危患者（87.7%）在SCAP后未接受ADT。这分别对应5年无ADT生存率为60.7%、73.9%和82.4%。SCAP后前列腺特异性抗原（PSA）最低点<0.2 ng/mL的患者5年无ADT生存率为87.1%，而PSA最低点≥0.2 ng/mL的患者为48.7%。术前使用ADT或全腺与部分腺SCAP对术后ADT使用无影响。在118例（55.4%）术后生化复发患者中，未使用ADT。
对于放疗后局部复发的患者，SCAP是一种有很大机会避免或延缓ADT的选择。在讨论放疗后局部复发性前列腺癌的治疗方案时，延缓ADT及其相关副作用的可能性应成为与患者咨询的一部分。避免ADT比PSA升高在临床上更具相关性。
