Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy
Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy
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DOI：
10.1111/bju.12151
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发表时间：
2013-08-01
影响因子：
4.5
通讯作者：
Ukimura, Osamu
中科院分区：
文献类型：
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作者：
Abreu, Andre Luis de Castro;Bahn, Duke;Ukimura, Osamu
目的探讨原发性放疗失败后复发性前列腺癌（PCa）行保留局灶性（SFC）和保留全灶性（STC）冷冻消融治疗的肿瘤学和功能预后。患者和方法从2003年3月到2010年8月，50例活检证实单侧（n = 25）或双侧（n = 25）放射复发性前列腺癌分别行SFC或STC。治疗后通过前列腺特异性抗原（PSA）检测、经直肠超声检查、活检和问卷调查对患者进行评估。采用Phoenix标准（PSA最低点+ 2 mg/mL）定义生化失败（BF）。前瞻性收集数据并进行回顾性分析。结果SFC冷冻消融前PSA水平和Gleason评分中位数分别为2.8 ng/mL和7，STC为3.9 ng/mL和7。SFC和STC的中位随访时间分别为31个月和53个月（P = 0.004）。肿瘤结果如下：无患者死亡；一例STC患者发生骨转移；8例SFC患者和3例STC患者有BF， 5年无BF生存率分别为54%和86%。在没有BF的患者中，SFC患者的平均PSA在第一年下降了86%，STC患者的平均PSA下降了90%，并保持稳定。功能结果如下：STC组中有3例（13%）患者出现新发尿失禁，而SFC组中没有患者出现尿失禁（P = 0.10）；SFC组7例患者中2例术后药力保留，而STC组4例患者术后药力均未恢复（P = 0.48）；STC组1例（4%）患者出现直肠尿道瘘，SFC组无一例（P = 0.48）。结论ssfc和STC是可行、安全的，中期肿瘤预后可接受。对于精心挑选的患者，与STC相比，SFC是一种治疗相关发病率较低的选择。虽然需要更长时间的随访和更多的患者数量，但我们的SFC和STC的初步肿瘤和功能结果令人鼓舞。
ObjectivesTo present the oncological and functional outcomes of salvage focal (SFC) and salvage total (STC) cryoablation for recurrent prostate cancer (PCa) after failed primary radiotherapy.Patients and MethodsFrom March 2003 to August 2010, 50 men with biopsy-proven unilateral (n = 25) or bilateral (n = 25) radio-recurrent PCa underwent SFC or STC, respectively.Patients were assessed after treatment by prostate-specific antigen (PSA) testing, transrectal ultrasonography, biopsy and questionnaires. Biochemical failure (BF) was defined using the Phoenix criteria (PSA nadir + 2 mg/mL).Data were prospectively collected and retrospectively analysed.ResultsThe median pre-cryoablation PSA level and Gleason score were, respectively, 2.8 ng/mL and 7 for SFC, and 3.9 ng/mL and 7 for STC. The median follow-up was 31 and 53 months (P = 0.004) for SFC and STC, respectively.Oncological outcomes were as follows: no patient died; one patient who underwent STC developed bone metastases; eight patients who underwent SFC and three who underwent STC had BF and the 5-year BF-free survival rates were 54 and 86%, respectively. In those patients without BF, the mean PSA decreased by 86% for SFC and 90% for STC within the first year and remained stable.Functional outcomes were as follows: new onset urinary incontinence occurred in three (13%) patients in the STC group, whereas no patient in the SFC group developed incontinence (P = 0.10); Two of seven patients in the SFC group retained postoperative potency, but none of the four potent patients in the STC group recovered potency postoperatively (P = 0.48); one (4%) patient in the STC group developed a recto-urethral fistula, but none occurred in the SFC group (P = 0.48).ConclusionsSFC and STC are feasible and safe with acceptable mid-term oncological outcomes. For carefully selected patients, SFC is an option that could be associated with lower treatment-related morbidity compared with STC. Although longer follow-up and more patient numbers are needed, our initial oncological and functional outcomes of SFC and STC are encouraging.