Proactive rectal warming during total-gland prostate cryoablation

Chen, Chung‐Hsin; Pu, Yeong-Shiau

doi:10.1016/j.cryobiol.2014.03.004

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…The resulting high toxicity led to more stringent patient selection and less aggressive freezing. Also precautions have been taken to minimise the risk of damaging the rectum by placing needles in the active wall for active warming [32,33]. Another possibly contributing factor may be that current RT techniques and doses differ from those being applied in the past, and this may also have altered the risk of fistula.…”

Section: Discussionmentioning

confidence: 99%

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

et al. 2020

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Objectives To evaluate the oncological and functional outcomes of salvage cryosurgery (SCS) for radiorecurrent prostate cancer (rrPCa). Patients and Methods A total of 169 consecutive patients with biopsy confirmed rrPCa were retrospectively analysed. All patients underwent SCS in a single referral centre between 2006 and 2018. The primary outcome was biochemical recurrence‐free survival (BRFS) according to the Phoenix definition (prostate‐specific antigen [PSA] nadir +2 ng/mL). The secondary outcomes were overall survival, BRFS defined as a PSA level of >0.5 ng/mL, metastasis‐free survival, androgen‐deprivation therapy (ADT)‐free survival, and functional outcomes. Complications were classified according to the Clavien–Dindo system. PSA was measured every 3–6 months postoperatively. Functional outcomes were scored as reported by patients at outpatient visits. Kaplan–Meier survival analysis and uni‐ and multivariable Cox regression were performed. Results The median (interquartile range) follow‐up was 36 (18–66) months. The BRFS after 5 and 8 years was 52% (95% confidence interval [CI] 43–62%) and 45% (95% CI 35–57%), respectively. At multivariable analysis PSA level at initial diagnosis, initial treatment, interval between primary treatment and SCS, age at SCS, and post‐SCS PSA nadir were significant factors for BRFS. The 5‐year ADT‐free survival was 70% (95% CI 62–79%). Clavien–Dindo Grade ≥III complications occurred in 1.2% (two/169) of patients. In all, 19% (29/156) of patients had new‐onset urinary incontinence defined as >1 pad/24 h and 92% (57/62) of patients had new‐onset erectile dysfunction. Persistent urinary fistula occurred in 6.5% (11/169) of patients. Conclusions The present study shows acceptable oncological outcomes of SCS considering the salvage character of the treatment. The occurrence of serious complications such as urinary incontinence and fistula should not be underestimated.

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Section: Discussionmentioning

confidence: 99%

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

et al. 2020

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“…CH Chen and YS Pu. The detailed surgical procedures were described in the previous published article [11]. All patients were followed using the same protocol, including PSA every 3 months in the first year, every 6 months in the 2nd to 5th years, and then annually.…”

Section: Clinical Information Collectionmentioning

confidence: 99%

Primary Total Prostate Cryoablation for Localized High-Risk Prostate Cancer: 10-Year Outcomes and Nomograms

Chen,

Tsai,

2023

Cancers

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The role of prostate cryoablation was still uncertain for patients with high-risk prostate cancer (PC). This study was designed to investigate 10-year disease-free survival and establish a nomogram in localized high-risk PC patients. Between October 2008 and December 2020, 191 patients with high-risk PC who received primary total prostate cryoablation (PTPC) were enrolled. The primary endpoint was biochemical recurrence (BCR), defined using Phoenix criteria. The performance of pre-operative and peri-operative nomograms was determined using the Harrell concordance index (C-index). Among the cohort, the median age and PSA levels at diagnosis were 71 years and 12.3 ng/mL, respectively. Gleason sum 8–10, stage ≥ T3a, and PSA > 20 ng/mL were noted in 27.2%, 74.4%, and 26.2% of patients, respectively. During the median follow-up duration of 120.4 months, BCR-free rates at 1, 3, 5, and 10 years were 92.6%, 76.6%, 66.7%, and 50.8%, respectively. The metastasis-free, cancer-specific, and overall survival rates were 89.5%, 97.4%, and 90.5% at 10 years, respectively. The variables in the pre-operative nomogram for BCR contained PSA at diagnosis, clinical stage, and Gleason score (C-index: 0.73, 95% CI, 0.67–0.79). The variables in the peri-operative nomogram for BCR included PSA at diagnosis, Gleason score, number of cryoprobes used, and PSA nadir (C-index: 0.83, 95% CI, 0.78–0.88). In conclusion, total prostate cryoablation appears to be an effective treatment option for selected men with high-risk PC. A pre-operative nomogram can help select patients suitable for cryoablation. A peri-operative nomogram signifies the importance of the ample use of cryoprobes and helps identify patients who may need early salvage treatment.

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“…Het hoge risico op toxiciteit heeft geleid tot een strengere patiëntselectie en minder agressief bevriezen. Daarnaast zijn er ook maatregelen genomen om het risico van rectumschade te minimaliseren door extra naalden in de rectumwand te plaatsen voor active warming [26,27]. Daarnaast kan het risico op fistelvorming zijn verminderd doordat de techniek die bij radiotherapie wordt gebruikt, is verbeterd en de doseringen zijn aangepast.…”

Section: Functionele Uitkomsten En Toxiciteitunclassified

Functionele en oncologische uitkomsten van salvage cryochirurgie voor lokaal recidief prostaatcarcinoom na radiotherapie

Nuijens

Exterkate²,

Dijkstra³

et al. 2021

Tijdschr Urol

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SamenvattingHet doel van deze studie was de oncologische en functionele uitkomsten van salvage cryochirurgie (sCC) te beoordelen bij lokaal recidief prostaatcarcinoom na radiotherapie (rrPCA). De studie werd uitgevoerd bij 169 patiënten. Er vond retrospectieve analyse plaats van recidiefvrije overleving (BRFS), algehele overleving, metastasevrije overleving, androgeendeprivatietherapie (ADT)-vrije overleving, functionele uitkomsten en complicaties. De mediane follow-up was 36 maanden (IQR = 18–66). BRFS na vijf en acht jaar was 52% (95%-BI = 43–62) en 45% (95%-BI = 35–57), respectievelijk. PSA bij initiële diagnose, de initiële behandeling, het interval tussen de primaire behandeling en SCS, leeftijd bij SCS en post-SCS PSA-nadir waren significante voorspellers van BRFS. De vijf-jaars ADT-vrije overleving was 70% (95%-BI = 62–79). Complicaties van graad III of hoger traden op bij 1,2% van de patiënten. Bij 19% en 92% van de patiënten trad new onset urine-incontinentie respectievelijk erectiele disfunctie op, bij 6,5% persisterende urinaire fistels en bij 12% desobstructie. SCS heeft aanvaardbare oncologische resultaten, maar kan gepaard gaan met ernstige complicaties (urine-incontinentie, stenose en fistels).

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Proactive rectal warming during total-gland prostate cryoablation

Cited by 9 publications

References 13 publications

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

Primary Total Prostate Cryoablation for Localized High-Risk Prostate Cancer: 10-Year Outcomes and Nomograms

Functionele en oncologische uitkomsten van salvage cryochirurgie voor lokaal recidief prostaatcarcinoom na radiotherapie

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