冷凍及高能聚焦超音波治療侷限性前列腺癌術後腫瘤及功能性結果之比較
柳易揚1、江博暉2
雲林長庚紀念醫院 泌尿科1；高雄長庚紀念醫院 泌尿科2
Comparisons of oncological and functional outcomes between primary whole-gland cryoablation and high-intensity focused ultrasound for localized prostate cancer
Yi Yang Liu1, Po Hui Chiang2
Department of Urology, Yunlin Chang Gung Memorial Hospital, Yunlin, Taiwan1;
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan2
Purpose: To conduct a prospective, single institutional comparison for primary whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in localized prostate cancer with respects to oncological and functional outcomes.
Materials and Methods: We enrolled 114 and 120 patients of primary whole-gland cryoablation and HIFU for localized prostate cancer from October 2008 to December 2013. PSA biochemical recurrence defined by Phoenix definition, salvage treatment-free rate, metastasis-free rate, and PSA biochemical recurrence-free survival analyzed by Kaplan-Meier method were for oncological outcomes. Functional outcomes included complications and serial IIEF-5 scores, IPSS and related QoL scores.
Results: During the mean follow-up duration of about 2 years, the PSA biochemical recurrence rates of the two groups were similar (cryoablation 25.4%, HIFU 18.3%). In terms of functional outcomes, the patients of HIFU had significantly lower IPSS (5.70 vs 9.04 at 24 months, P = 0.030), lower erectile dysfunction rate (65.6% vs 88.0%, P= 0.015) and higher IIEF-5 score (9.36 vs 4.18 at 24 months, P = 0.028) than did the patients of cryoablation.
Conclusion: In this study, both primary whole-gland cryoablation and HIFU demonstrated good oncological outcomes for localized prostate cancer. Besides, we validated the safety of the two treatment modalities and identified the importance of combined HIFU and TURP. The HIFU patients experienced better urinary function improvement and more possible sexual function preservation than did the cryoablation patients; therefore, HIFU may provide better quality of life for patients of localized prostate cancer.