冷冻治疗单病灶前列腺癌12例临床分析

Focal cryoablation for unifocal prostate cancer： report of 12 cases

目的评价冷冻疗法治疗局限性单病灶前列腺癌的近期疗效及安伞性。方法局限性单病灶前列腺癌患者12例，均经穿刺活检证实。术前PSA4．2～14．9ng／ml，平均9．7ng／ml。Gleason评分5分3例，6分5例，7分4例。临床分期T1c期8例、T2a期4例。均行超声引导下经会阴前列腺局灶冷冻治疗。术后1年内每3个月、以后每6个月复金PSA。PSA最低值≥1．0ng／ml或PSA达最低值后上升〉2．0ng／ml者再次行前列腺穿刺活检排除肿瘤复发。结果12例手术顺利，丁术时间（82±26）min，均未输血。术后住院（5±2）d。拔除尿管后，12例控尿均满意。术前有勃起功能着10例，术后仍保持勃起功能者8例。12例随访12～30个月，平均23个月。术后PSA最低值0．1～6．8ng／ml，平均2．2ng／ml，其中〈1．0ng／ml者9例。术后PSA异常行前列腺穿刺活检4例，阴性3例，冷冻对侧腺体活检阳性1例。结论超声引导下经会阴前列腺局灶冷冻治疗安全有效、并发症少，可用于局限性单病灶前列腺癌患者，远期疗效尚需进一步观察。

Objective To evaluate term efficacy of focal cryoablation for localized single lesion prostate cancer and the protection of erectile function. Methods From June 2008 to December 2009, 12 patients with localized single lesion prostate cancer were treated with focal cryoablation. All diagnoses were confirmed by transrectal ultrasound-guided prostatic biopsy. The mean Gleason score was ≤ 7; three cases had a Gleason score of 5, five cases a score of 6, and four cases a score of 7. The average preoperative value of PSA was 9.7 ng/ml （4.2 -14.9 ng/ml）. The PSA level was obtained every three months for the first year and then every six months thereafter. Patients with a PSA nadir greater than 1.0 ng/ml or if the PSA nadir increased more than 2 ng/ml underwent repeat biopsy to exclude tumor recurrence. Results The mean operative time was （82 ± 26） minutes. The mean postoperative hospital stay was （5 ± 2） days. After catheter removal, all 12 cases had good continence and 10 had erectile function before surgery. Of the 10 patients, eight had erectile function after surgery. The follow - up ranged from 12 to 30 months （ mean 23 ）. The lowest average serum PSA nadir was 2.2 ng/ml, nine patients had a minimum PSA nadir of less than 1.0 ng/ml and three had a minimum PSA nadir of more than 1.0 ng/ml. Four patients underwent repeat biopsy after abnormal PSA, and prostate cancer was detected in the contralateral gland in one patient. Conclusions Ultrasound-guided transperineal focal cryoablation is a safe and effective treatment with few com- plications for localized single lesion prostate cancer. Additional studies with longer follow-up are necessary for long-term efficacy.