Department of Urology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Urol. 2021 Sep;206(3):646-654. doi: 10.1097/JU.0000000000001831. Epub 2021 Apr 18.
Radiation refractory prostate cancer (RRPCa) is common and salvage cryotherapy for RRPCa is emerging as a viable local treatment option. However, there is a paucity of long-term data. The purpose of this study is to determine long-term outcomes following salvage cryotherapy for RRPca.
Patients undergoing salvage cryotherapy for biopsy-proven, localized RRPCa from 1992 through 2004 were prospectively accrued at two centers. Preoperative characteristics, perioperative morbidity and postoperative data were reviewed from our database. The primary outcomes were overall survival (OS) and disease-specific survival (DSS). The secondary outcomes were freedom from castration-resistant prostate cancer (CRPC) and freedom from androgen deprivation therapy (ADT).
A total of 268 patients were identified with a median followup of 10.3 years. A total of 223 complication events were recorded; of them, 168 were Clavien I-II events and 55 Clavien III events. At 10 years, 69% had freedom from ADT and 76% had freedom from CRPC. The 10-year DSS rate was 81%, and the 10-year OS rate was 77%. A pre-salvage prostate specific antigen level of >10 ng/ml was associated with an increased risk of developing CRPC and initiation of ADT but was not associated with DSS or OS. The use of neoadjuvant ADT was associated with improved OS and DSS but did not affect freedom from CRPC or adjuvant ADT.
Salvage cryotherapy for RRPCa provides excellent long-term freedom from ADT, CRPC and DSS with acceptable morbidity. OS at 10 years was 77%. Prospective trials are required for validation.
放射性难治性前列腺癌（RRPCa）较为常见，挽救性冷冻治疗作为 RRPCa 的一种可行局部治疗选择，正在不断发展。然而，目前缺乏长期数据。本研究旨在确定 RRPCa 行挽救性冷冻治疗后的长期结果。
1992 年至 2004 年，在两个中心前瞻性地连续招募了经活检证实为局限性 RRPCa 并接受挽救性冷冻治疗的患者。我们从数据库中回顾了术前特征、围手术期发病率和术后数据。主要结局为总生存率（OS）和疾病特异性生存率（DSS）。次要结局为无去势抵抗性前列腺癌（CRPC）生存率和无雄激素剥夺治疗（ADT）生存率。
共确定了 268 例患者，中位随访时间为 10.3 年。共记录了 223 例并发症事件，其中 168 例为 Clavien I-II 级事件，55 例为 Clavien III 级事件。10 年时，69%的患者无 ADT，76%的患者无 CRPC。10 年 DSS 率为 81%，10 年 OS 率为 77%。挽救性冷冻治疗前前列腺特异性抗原（PSA）水平>10ng/ml 与发生 CRPC 和开始 ADT 的风险增加相关，但与 DSS 或 OS 无关。新辅助 ADT 的使用与 OS 和 DSS 的改善相关，但不影响 CRPC 或辅助 ADT 的发生。
RRPCa 行挽救性冷冻治疗可获得极好的长期无 ADT、CRPC 和 DSS 生存率，且发病率可接受。10 年 OS 率为 77%。需要前瞻性试验进行验证。
