前列腺冷冻消融术后肿瘤局部复发行挽救性治疗的临床分析

Effects of salvage therapies for local recurrence of tumor following prostate cryoablation

目的探讨前列腺冷冻消融术后出现肿瘤局部复发的挽救性治疗方案的疗效及安全性,为该类患者的治疗选择提供参考。方法回顾性分析2014年6月—2020年12月于中山大学肿瘤防治中心接受前列腺冷冻消融术后出现肿瘤局部复发的前列腺癌(cT1c~4N0M0)患者的临床资料。对患者开展的挽救性治疗方法包括局部治疗(挽救性放疗、挽救性冷冻消融、挽救性前列腺癌根治术)和雄激素剥夺治疗(ADT),挽救性治疗后进行了规律随访。结果共8例患者符合入组条件。患者中位年龄为71(63~76)岁,患者中位初诊PSA为17.650(10.380~325.10)ng/mL,初次冷冻消融后中位最低PSA为0.041(0.003~0.541)ng/mL。患者局部复发时中位PSA为3.030(2.090~19.180)ng/mL。3例直肠指诊触及硬结,7例影像学提示局部复发,4例患者接受前列腺穿刺活检术,其中2例活检阳性。挽救性治疗后中位随访时间为54(9~75)个月。4例患者行挽救性放疗,其中2例分别出现血便、血尿、尿路感染,经保守治疗后恢复;1例患者接受挽救性冷冻消融,术后无并发症;1例患者接受前列腺癌根治术(RP)+放疗,根治术后出现淋巴漏,经保守治疗后恢复。2例患者接受单独ADT治疗,其中1例出现潮热,后自行好转。1例接受单独ADT治疗的患者,63个月后出现肿瘤进展,其余患者至随访截止前未出现肿瘤进展和死亡。结论对前列腺冷冻消融术后出现肿瘤局部复发的患者可以考虑进行局部治疗(挽救性放疗、冷冻消融、RP)和ADT,但各种治疗方法的疗效及安全性还需要大规模前瞻性研究的进一步证实。

Objective To explore the effectiveness and safety of different salvage therapies for local recurrence of tumor following primary prostate cryoablation so as to provide the reference for the treatment of prostate similar cases.Methods The clinical data of patients with prostate cancer(cT1c-4N0M0)who received salvage therapy for local recurrence of tumor following primary prostate cryoablation in the Sun Yat-Sen University Cancer Center during June 2014 and Dec.2020 were retrospectively analyzed.Salvage therapies included local therapy(salvage radiotherapy,salvage cryoablation or salvage radical prostatectomy)and androgen deprivation therapy(ADT).Results Altogether 8 patients were involved.The median age was 71(63-76)years,the median prostate specific antigen(PSA)at the first diagnosis was 17.650(10.380-325.100)ng/mL,the median nadir post-cryoablation PSA was 0.041(0.003-0.541)ng/mL,and the median PSA at local recurrence was 3.030(2.090-19.180)ng/mL.Abnormal digital rectal examination was found in 3 cases,and radiographic evidence of local recurrence was found in 7 cases.Prostate biopsy was performed in 4 cases,2 of which had positive results.The median follow-up after salvage therapy lasted for 54(9-75)months.Four cases received salvage radiotherapy,2 of which developed bloody stool,hematuresis and urinary tract infection,and recovered after conservative treatment;1 case received salvage cryoablation without side effects;1 case underwent radical prostatectomy and radiotherapy,developed lymphorrhagia and recovered after conservative treatment;2 cases received ADT alone,one experienced hot flashes and recovered after conservative treatment,and the other progressed into castration-resistant prostate cancer after 63 months.No other progression or death occurred at the termination of follow-up.Conclusion Salvase therapy(salvage radiotherapy,salvage cryoablation,salvage radical prostatectomy)and ADT can be used for local recurrence of tumor following primary prostate cryoablation.However,large-scale prospective research is needed to confirm the effectiveness and safety of different therapies.