Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.
State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China.
Prostate Cancer Prostatic Dis. 2021 Sep;24(3):837-844. doi: 10.1038/s41391-021-00335-2. Epub 2021 Mar 4.
Several studies showed that androgen deprivation therapy (ADT) plus local treatment of prostate could improve metastatic prostate cancer (mPCa) patients' survival. To date there are few studies analyzed the value of prostate cryoablation in mPCa. The objective of our analysis is to evaluate the oncological results and clinical value of prostate cryoablation combined with ADT compared with ADT alone in newly diagnosed mPCa patients.
Newly diagnosed mPCa patients undergoing cryoablation plus ADT (group A) between January 2011 and November 2018 were identified. Patients receiving ADT alone (group B) were selected from the same institutional prostate cancer database by propensity score matching based on clinical characteristics. Oncological results and clinical value in symptom control and primary lesion treatment were compared.
Fifty-four patients were included in each group. Prostate cryoablation was well tolerated. The median follow-up time was 40 (27-53) and 39 (31-54) months in group A and group B, respectively. Patients in group A had a lower median prostate-specific antigen (PSA) nadir (0.025 ng/mL vs. 0.230 ng/mL, p = 0.001), longer median failure-free survival (FFS) (39 months vs. 21 months, p = 0.005), and median metastatic castration-resistant prostate cancer (mCRPC)-free survival (39 months vs. 21 months, p = 0.007). No difference in cancer-specific survival and overall survival was found between the two groups. Multivariate Cox analysis showed combination therapy reduced the risk of FFS by 45.8% (HR = 0.542 [95% CI 0.329-0.893]; p = 0.016). Patients in group A had better clinical relief of urinary symptoms (79.1 vs. 59.1%, p = 0.044) and required less treatment of primary lesions for symptomatic relief (13.0 vs. 31.5%, p = 0.021).
Prostate cryoablation plus ADT decreases PSA nadir, prolongs FFS and mCRPC-free survival, relieves urinary symptoms and reduces the need for treating primary lesions in newly diagnosed mPCa patients compared to ADT alone.
多项研究表明，去势治疗（ADT）联合前列腺局部治疗可改善转移性前列腺癌（mPCa）患者的生存。迄今为止，很少有研究分析前列腺冷冻消融术在 mPCa 中的价值。我们分析的目的是评估与单独 ADT 相比，新诊断的 mPCa 患者中前列腺冷冻消融术联合 ADT 的肿瘤学结果和临床价值。
确定 2011 年 1 月至 2018 年 11 月期间接受冷冻消融术联合 ADT（A 组）的新诊断 mPCa 患者。通过基于临床特征的倾向评分匹配，从同一机构前列腺癌数据库中选择单独接受 ADT（B 组）的患者。比较两组在症状控制和原发灶治疗方面的肿瘤学结果和临床价值。
每组 54 例患者。前列腺冷冻消融术耐受良好。A 组和 B 组的中位随访时间分别为 40（27-53）和 39（31-54）个月。A 组患者的中位前列腺特异性抗原（PSA）最低值（0.025ng/mL 比 0.230ng/mL，p=0.001）、中位无失败生存期（FFS）（39 个月比 21 个月，p=0.005）和中位转移性去势抵抗性前列腺癌（mCRPC）无进展生存期（39 个月比 21 个月，p=0.007）均较低。两组间癌症特异性生存率和总生存率无差异。多变量 Cox 分析显示，联合治疗可使 FFS 风险降低 45.8%（HR=0.542[95%CI 0.329-0.893]；p=0.016）。A 组患者的尿症状临床缓解率更好（79.1%比 59.1%，p=0.044），需要治疗原发灶缓解症状的比例更低（13.0%比 31.5%，p=0.021）。
与单独 ADT 相比，新诊断的 mPCa 患者中，前列腺冷冻消融术联合 ADT 可降低 PSA 最低值、延长 FFS 和 mCRPC 无进展生存期、缓解尿症状并降低治疗原发灶的需求。
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