Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
Actas Urol Esp (Engl Ed). 2020 Apr;44(3):172-178. doi: 10.1016/j.acuro.2019.10.003. Epub 2020 Feb 5.
To compare oncological, functional and post-operative outcomes of hemi (HC) vs. whole gland (WGC) cryoablation as first line treatment of localized prostate cancer.
Sixty-six consecutive patients undertaking whole-gland cryoablation (WGC=40) or hemi-cryoablation (HC=26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D'Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir+≥ 2 ng/mL), 2) positive prostate re-biopsy with Gleason score ≥ 7, 3) initiation of further prostate cancer treatment.
Median patients age at treatment was 74 [42-81] vs. 76 [71-80] years in WGC vs. HC group, respectively (p=.08). Low and intermediate D'Amico risk group were 15% and 85% vs. 23% and 77% (p=.75), respectively. Median follow- up time was 41 [1.5-99.0] vs. 27 [0.9-93] months (p=.03). Four-years cryotherapy failure free survival in WGC vs. HC were 69% vs. 53% with definition 1 (p=.24), 82% vs. 80% with definition 2 (p=.95), 83% vs. 77% with definition 3 (p=.73). Early and 1-year urinary continence were 60% and 83% in WGC vs. 72% and 83% in HC (p=.26). De novo impotency after cryotherapy was 75% vs. 46% (p=.33) in WGC vs. HC.
In our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation.
比较半腺体（HC）与全腺体（WGC）冷冻消融作为局限性前列腺癌一线治疗的肿瘤学、功能和术后结果。
纳入 2010 年至 2018 年间在三级转诊中心接受全腺体冷冻消融（WGC=40 例）或半腺体冷冻消融（HC=26 例）的 66 例连续患者。所有患者根据 D'Amico 风险分类为低-中危前列腺癌。在活检和前列腺 MRI 证实单侧前列腺癌的情况下，提出半切除。主要终点是冷冻消融失败，考虑并比较了 3 种定义：1）生化失败（> PSA 最低点+≥ 2ng/ml），2）前列腺再活检阳性且 Gleason 评分≥7，3）开始进一步的前列腺癌治疗。
治疗时患者年龄中位数为 74 [42-81]岁，WGC 组与 HC 组分别为 76 [71-80]岁（p=0.08）。低危和中危 D'Amico 风险组分别为 15%和 85%，WGC 组与 HC 组分别为 23%和 77%（p=0.75）。中位随访时间为 41 [1.5-99.0]与 27 [0.9-93]个月（p=0.03）。WGC 组与 HC 组的 4 年冷冻消融无失败生存率分别为 69%和 53%，定义 1（p=0.24），82%和 80%，定义 2（p=0.95），83%和 77%，定义 3（p=0.73）。WGC 组与 HC 组的早期和 1 年尿控率分别为 60%和 83%，72%和 83%（p=0.26）。WGC 组与 HC 组冷冻消融后新发勃起功能障碍分别为 75%和 46%（p=0.33）。
在我们这组选择的单侧低/中危前列腺癌患者中，与全腺体冷冻消融相比，半腺体冷冻消融可能提供相似的肿瘤学结果和更少的早期并发症。
