Exterkate Leonie, Peters Max, Somford Diederik M, Vergunst Henk
Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
BJU Int. 2021 Jul;128(1):46-56. doi: 10.1111/bju.15269. Epub 2020 Nov 4.
To evaluate the oncological and functional outcomes of salvage cryosurgery (SCS) for radiorecurrent prostate cancer (rrPCa).
A total of 169 consecutive patients with biopsy confirmed rrPCa were retrospectively analysed. All patients underwent SCS in a single referral centre between 2006 and 2018. The primary outcome was biochemical recurrence-free survival (BRFS) according to the Phoenix definition (prostate-specific antigen [PSA] nadir +2 ng/mL). The secondary outcomes were overall survival, BRFS defined as a PSA level of >0.5 ng/mL, metastasis-free survival, androgen-deprivation therapy (ADT)-free survival, and functional outcomes. Complications were classified according to the Clavien-Dindo system. PSA was measured every 3-6 months postoperatively. Functional outcomes were scored as reported by patients at outpatient visits. Kaplan-Meier survival analysis and uni- and multivariable Cox regression were performed.
The median (interquartile range) follow-up was 36 (18-66) months. The BRFS after 5 and 8 years was 52% (95% confidence interval [CI] 43-62%) and 45% (95% CI 35-57%), respectively. At multivariable analysis PSA level at initial diagnosis, initial treatment, interval between primary treatment and SCS, age at SCS, and post-SCS PSA nadir were significant factors for BRFS. The 5-year ADT-free survival was 70% (95% CI 62-79%). Clavien-Dindo Grade ≥III complications occurred in 1.2% (two/169) of patients. In all, 19% (29/156) of patients had new-onset urinary incontinence defined as >1 pad/24 h and 92% (57/62) of patients had new-onset erectile dysfunction. Persistent urinary fistula occurred in 6.5% (11/169) of patients.
The present study shows acceptable oncological outcomes of SCS considering the salvage character of the treatment. The occurrence of serious complications such as urinary incontinence and fistula should not be underestimated.
评估挽救性冷冻消融术（SCS）治疗放射性复发前列腺癌（rrPCa）的肿瘤学及功能学结果。
对169例经活检确诊为rrPCa的连续患者进行回顾性分析。所有患者于2006年至2018年在单一转诊中心接受了SCS治疗。主要结局为根据Phoenix定义的无生化复发生存期（BRFS）（前列腺特异性抗原[PSA]最低点+2 ng/mL）。次要结局包括总生存期、定义为PSA水平>0.5 ng/mL的BRFS、无转移生存期、无雄激素剥夺治疗（ADT）生存期以及功能学结果。并发症根据Clavien-Dindo系统进行分类。术后每3 - 6个月测量一次PSA。功能学结果由患者在门诊就诊时报告进行评分。进行了Kaplan-Meier生存分析以及单变量和多变量Cox回归分析。
中位（四分位间距）随访时间为36（18 - 66）个月。5年和8年的BRFS分别为52%（95%置信区间[CI] 43 - 62%）和45%（95% CI 35 - 57%）。多变量分析显示，初始诊断时的PSA水平、初始治疗、初次治疗与SCS之间的间隔时间、SCS时的年龄以及SCS后的PSA最低点是BRFS的显著影响因素。5年无ADT生存期为70%（95% CI 62 - 79%）。Clavien-Dindo≥III级并发症发生在1.2%（2/169）的患者中。总体而言，19%（29/156）的患者出现新发性尿失禁，定义为>1片/24小时，92%（57/62）的患者出现新发性勃起功能障碍。持续性尿瘘发生在6.5%（11/169）的患者中。
考虑到该治疗的挽救性质，本研究显示SCS具有可接受的肿瘤学结果。尿失禁和尿瘘等严重并发症的发生不应被低估。
