Department of Radiology, Hôpital Cochin, AP-HP, & Université de Paris-Descartes Paris 5,, 75014 Paris, France.
Department of Radiology, Hôpital Saint-Louis, APHP & Université de Paris-Diderot Paris 7, 75010 Paris, France.
Diagn Interv Imaging. 2019 Nov;100(11):679-687. doi: 10.1016/j.diii.2019.07.001. Epub 2019 Jul 19.
The purpose of this study was to determine the efficacy of salvage cryotherapy for intra-prostatic and local extraprostatic recurrences after curative treatment of prostate adenocarcinoma.
Twenty-eight men (mean age, 69±6 [SD] years; range: 51-82 years) treated with cryoablation for prostatic (N=21) or extraprostatic (N=7) recurrent prostate cancer after radiotherapy with or without associated prostatectomy were included. Technical success, complication and recurrences were reported. Biological recurrence was defined as an elevation ≥2ng/mL of prostate specific antigen (PSA) serum level after the treatment.
The mean follow-up was 18 months. Among the 21 patients with intraprostatic recurrence, 14 had successful cryotherapy with a mean decrease in serum prostate-specific antigen (PSA) levels of -5.7±2.6 (SD) ng/mL (range: -2.1 to -16.9ng/mL). Four patients (19%) had early progression and three patients (14%) had delayed biological recurrence (mean time: 15 months). Among the 7 patients with extraprostatic recurrence, 2/7 (291%) had successful cryotherapy with a decrease in PSA serum level of -2.7±1.6 (SD) ng/mL (range: -0.5--5.5ng/mL) and 4/7 (57%) had early biological recurrence after cryotherapy that required androgen deprivation therapy, whereas 1/7 (4%) was lost to follow-up. No major complications were observed for both intra- and extraprostatic recurrence.
Salvage cryoablation of locally recurrent prostate cancer after curative treatment is feasible and safe when the half prostate is treated. It could delay initiation of androgen deprivation therapy in these patients.
本研究旨在确定补救性冷冻治疗在前列腺腺癌根治性治疗后前列腺内和局部前列腺外复发的疗效。
28 名男性（平均年龄 69±6[SD]岁；范围：51-82 岁）因放射治疗（包括或不包括前列腺切除术）后出现前列腺（N=21）或前列腺外（N=7）局部复发而接受冷冻消融治疗，纳入本研究。报告了技术成功率、并发症和复发情况。生物复发定义为治疗后前列腺特异性抗原（PSA）血清水平升高≥2ng/mL。
平均随访时间为 18 个月。21 名前列腺内复发患者中，14 名患者冷冻治疗成功，血清前列腺特异性抗原（PSA）水平平均下降-5.7±2.6（SD）ng/mL（范围：-2.1 至-16.9ng/mL）。4 名患者（19%）早期进展，3 名患者（14%）出现延迟性生物复发（平均时间：15 个月）。7 名前列腺外复发患者中，2/7（291%）冷冻治疗成功，PSA 血清水平下降-2.7±1.6（SD）ng/mL（范围：-0.5-5.5ng/mL），4/7（57%）冷冻治疗后早期出现生物复发，需要雄激素剥夺治疗，1/7（4%）失访。两种情况下均未观察到主要并发症。
根治性治疗后局部复发的前列腺癌进行补救性冷冻消融是可行和安全的，当治疗半侧前列腺时尤其如此。它可以延迟这些患者开始雄激素剥夺治疗的时间。
