The current and potential role of cryoablation as a primary therapy for localized prostate cancer.
The current and potential role of cryoablation as a primary therapy for localized prostate cancer.
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DOI：
10.1007/s11912-003-0115-6
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发表时间：
2003-05-01
影响因子：
4.7
通讯作者：
Rewcastle, John C
中科院分区：
文献类型：
--
作者：
Katz, Aaron E;Rewcastle, John C
自20世纪90年代初重新引入以来，前列腺的靶向冷冻消融术已经取得了显著进展。这种演变源于工程技术的进步，程序的完善，温度监测的引入，以及对低温生物学的更深入理解。最近的出版物证明了冷冻消融术的持久疗效，与低风险疾病的其他疗法相当，可能对中度和高度风险前列腺癌具有上级疗效。除性功能障碍外，与其他疗法相比，手术后的发病率较低。然而，长期的生活质量研究表明，大量患者恢复性交，未观察到迟发性疾病。这些结果与放射治疗（特别是近距离放射治疗）的结果形成对比，最近的几项研究记录了性功能下降，长期发病率和迟发性发病率的出现。冷冻消融术是一种有效的治疗方法，发病率可接受，应作为所有局限性前列腺癌患者的治疗选择。此外，冷冻消融术具有针对个体患者疾病定制的潜在能力。随着诊断工具和方法的不断进步，有可能靶向攻击性较低的前列腺癌。在这种情况下，局部冷冻消融可能被证明是一种理想的治疗方式。
Targeted cryoablation of the prostate has evolved significantly since its reintroduction in the early 1990s. This evolution stems from engineering advancements, procedural refinement, introduction of temperature monitoring, and greater understanding of cryobiology. Recent publications demonstrate durable efficacy for cryoablation, equivalent to other therapies for low-risk disease and possibly superior for moderate- and high-risk prostate cancer. Morbidity following the procedure is mild in comparison with other therapies, with the exception of sexual function impairment. However, longer-term quality-of-life studies show that a significant number of patients return to having intercourse, and late-onset morbidities are not observed. These results contrast with those for radiotherapy--specifically brachytherapy--for which several recent studies document a decline in sexual function, protracted morbidity, and the emergence of late-onset morbidity. Cryoablation is an effective therapy with acceptable morbidity that should be offered as a treatment option to all patients with localized prostate cancer. Furthermore, cryoablation has the potential ability to be tailored to an individual patient's disease. As diagnostic tools and methods continue to advance, it may become possible to target the less aggressive forms of prostate cancer. Focal cryoablation may prove to be an ideal treatment modality in this setting.