Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Urology, New York University Langone Health, New York, NY, USA.
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Eur Urol Oncol. 2023 Jun;6(3):289-294. doi: 10.1016/j.euo.2023.02.007. Epub 2023 Mar 6.
There is no consensus on the optimal approach for salvage local therapy in radiation-resistant/recurrent prostate cancer (RRPC).
To investigate oncological and functional outcomes for men treated with salvage whole-gland cryoablation (SWGC) of the prostate for RRPC.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed our prospectively collected cryosurgery database between January 2002 and September 2019 for men who were treated with SWGC of the prostate at a tertiary referral center.
SWGC of the prostate.
The primary outcome was biochemical recurrence-free survival (BRFS) according to the Phoenix criterion. Secondary outcomes included metastasis-free survival, cancer-specific survival, and adverse events.
A total of 110 men with biopsy-proven RRPC were included in the study. Median follow-up for patients without biochemical recurrence (BCR) after SWGC was 71 mo (interquartile range [IQR] 42.3-116). BRFS was 81% at 2 yr and 71% at 5 yr. A higher prostate-specific antigen (PSA) nadir after SWGC was associated with worse BRFS. The median International Index of Erectile Function-5 score was 5 (IQR 1-15.5) before SWGC and 1 (IQR 1-4) after SWGC. Stress urinary incontinence, strictly defined as the use of any pads after treatment, was 5% at 3 mo and 9% at 12 mo. Clavien-Dindo grade ≥3 adverse events occurred in three patients (2.7%).
In patients with localized RPPC, SWGC achieved excellent oncological outcomes with a low rate of urinary incontinence, and represents an alternative to salvage radical prostatectomy. Patients with fewer positive cores and lower PSA tended to have better oncological outcomes following SWGC.
For men with prostate cancer that persists after radiotherapy, a freezing treatment applied to the whole prostate gland can achieve excellent cancer control. Patients who did not have elevated prostate-specific antigen (PSA) at 6 years after this treatment appeared to be cured.
对于放射性抵抗/复发性前列腺癌（RRPC），尚无关于挽救性局部治疗的最佳方法的共识。
研究接受挽救性全腺体冷冻治疗（SWGC）治疗 RRPC 男性的肿瘤学和功能结局。
设计、地点和参与者：我们回顾性地分析了 2002 年 1 月至 2019 年 9 月期间在三级转诊中心接受前列腺 SWGC 治疗的男性的前瞻性收集的冷冻手术数据库。
SWGC 前列腺。
共纳入 110 例经活检证实的 RRPC 男性。SWGC 后无生化复发（BCR）患者的中位随访时间为 71 个月（四分位距[IQR]42.3-116）。2 年和 5 年的 BRFS 分别为 81%和 71%。SWGC 后前列腺特异性抗原（PSA）最低值越高，BRFS 越差。SWGC 前国际勃起功能指数-5 评分中位数为 5（IQR 1-15.5），SWGC 后为 1（IQR 1-4）。严格定义为治疗后使用任何护垫的压力性尿失禁发生率为 3 个月时为 5%，12 个月时为 9%。3 名患者（2.7%）发生 Clavien-Dindo 分级≥3 级不良事件。
对于局部 RRPC 患者，SWGC 实现了极好的肿瘤学结果，尿失禁发生率低，是挽救性根治性前列腺切除术的替代方法。SWGC 后，阳性核心数较少和 PSA 较低的患者肿瘤学结果较好。
对于放射治疗后仍存在前列腺癌的男性，应用于整个前列腺的冷冻治疗可以实现极好的癌症控制。接受这种治疗 6 年后前列腺特异性抗原（PSA）未升高的患者似乎已经治愈。
