目的:报告使用“曲棍球棒”模板对前列腺次全消融疗效的长期随访,包括肿瘤控制和生活质量(QoL)影响。
方法:我们进行了一项前瞻性对照试验,以评估在基线和确证活检显示分级组(GG)1-2前列腺癌的选定男性中前列腺次全消融的疗效。进行了包括同侧半腺和对侧前前列腺的“曲棍球棒”冷冻消融。区域消融术后6、18和36个月进行前列腺活检和QOL查询,并且更新了随访以包括随后的临床访问.
结果:在2009年8月至2012年1月期间,对72名男性进行了资格筛选,47名男性选择接受确诊活检。其中,23例被认为是合格的,并接受了区域性冷冻消融治疗。中位年龄为64岁。中位随访时间为74个月。单个患者具有<1mm的现场存活肿瘤,对36个月的活检具有治疗效果。在最后一次随访时,共有12/23(52%)的患者没有疾病的证据,所有患者均保留了尿液控制,没有患者需要尿失禁垫。性下降在3个月和6个月时显著(P<0.01),尽管在随后的时间点看到了改善。
结论:前列腺小计(曲棍球棒模板)冷冻消融术在一般低风险组的目标组织中提供肿瘤控制,对性功能和泌尿功能的影响最小。需要进一步的研究来评估这种消融模板在MRI靶向时代和高风险人群中的应用。
OBJECTIVE: To report long-term follow-up of the efficacy of subtotal prostate ablation using a \"hockey-stick\" template, including oncologic control and quality of life (QoL) impact.
METHODS: We performed a prospective controlled
trial to evaluate the efficacy of subtotal prostate ablation in selected men with baseline and confirmatory biopsy showing grade group (GG) 1-2 prostate cancer. \"Hockey-stick\" cryoablation that included the ipsilateral hemi-gland and contralateral anterior prostate was performed. Prostate biopsies and QOL queries were performed at 6, 18 and 36 months following regional ablation, and follow-up was updated to include subsequent clinic visits.
RESULTS: Between August 2009 and January 2012, 72 men were screened for eligibility and 47 opted to undergo confirmatory biopsy. Of these, 23 were deemed eligible and treated with regional cryoablation. Median age was 64 years. Median follow-up was 74 months. A single patient had < 1 mm of in-field viable tumor with therapy effect on 36-month biopsy. At time of last follow-up, a total of 12/23 (52%) patients did not have evidence of disease, all patients had preserved urinary control with no patients requiring pads for urinary incontinence. Sexual decline was significant at 3 and 6 months (P < 0.01 for both), though improvement was seen at subsequent time points.
CONCLUSIONS: Subtotal (hockey-stick template) cryoablation of the prostate provides oncologic control to targeted tissue in a generally low-risk group with minimal impact on sexual and urinary function. Further studies are needed to evaluate this ablation template in the MRI-targeted era and higher risk populations.