Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY.
Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY.
Urology. 2021 Oct;156:225-230. doi: 10.1016/j.urology.2021.01.040. Epub 2021 Feb 2.
To demonstrate the safety and efficacy of photoselective vaporization of the prostate in alleviating refractory lower urinary tract symptoms in prostate cancer patients who are managed with active surveillance and to explore the association of this procedure with prostate specific antigen (PSA) levels and cancer progression rates.
Between 2008-2018, active surveillance patients who had refractory symptoms and needed surgery were studied. Perioperative functional variables were collected and analyzed. Disease progression was defined as an upgrade or upstage on surveillance biopsies or multiparametric prostate magnetic resonance imaging. Mean postop scores were estimated using locally-weighted methods. The risk of progression was reported using Kaplan-Meier's method.
Seventy-one patients were included in the study. The median age was 68 years and the median surveillance time before surgery was 4 years. At 12 months, there were substantial improvements in the mean International Prostate Symptom Score (18-5.9), maximum flow rate (6.8-14 mL/s), postvoid residual (240-73mL), PSA (8.1-5.2 ng/mL), and prostate volume (85-57mL). At 30-days, only 2 patients with grade-III complications. Late consequences included tissue regrowth in 4 and urethral stricture (requiring a single dilation) in 3 patients. PSA levels decreased by 36% at 12 months postoperatively. With a median follow-up of 3.7 years, 7 men progressed and received radical treatment. At 3 years, the probability of remaining on surveillance was 93% (95% CI 87%- 100%).
Photoselective vaporization of the prostate offers substantial relief of symptoms in active surveillance patients with refractory symptoms, without adverse effects on disease progression rates.
展示前列腺光选择性汽化术在缓解主动监测管理的前列腺癌患者难治性下尿路症状方面的安全性和有效性，并探讨该手术与前列腺特异性抗原（PSA）水平和癌症进展率之间的关系。
在 2008 年至 2018 年期间，研究了有难治性症状且需要手术的主动监测患者。收集并分析围手术期功能变量。疾病进展定义为监测活检或多参数前列腺磁共振成像的升级或升级。使用局部加权法估计术后平均评分。使用 Kaplan-Meier 法报告进展风险。
本研究共纳入 71 例患者。中位年龄为 68 岁，手术前中位监测时间为 4 年。在 12 个月时，国际前列腺症状评分（18-5.9）、最大流量率（6.8-14mL/s）、残余尿量（240-73mL）、PSA（8.1-5.2ng/mL）和前列腺体积（85-57mL）有显著改善。在 30 天，只有 2 例患者出现 III 级并发症。晚期后果包括 4 例组织再生和 3 例尿道狭窄（需要单次扩张）。术后 12 个月 PSA 水平下降 36%。中位随访 3.7 年后，7 名男性进展并接受根治治疗。在 3 年时，继续监测的概率为 93%（95%CI 87%-100%）。
前列腺光选择性汽化术可为有难治性症状的主动监测患者提供显著的症状缓解，而不会对疾病进展率产生不利影响。
