Patients with localized recurrent prostate cancer (PCa) are eligible for androgen-deprivation therapy, salvage radical prostatectomy (RP) or radiation therapy. These treatments are associated with serious side-effects, illustrating the need for alternative local treatment options with lower morbidity rates. All patients who underwent magnetic resonance imaging (MRI)-guided salvage focal cryoablation (SFC) with localized recurrent PCa between 2011–2021 (n= 114) were included. Two subgroups were formed: patients without (n= 99) and with prior RP (n= 15). We assessed the recurrence- (RFS) and treatment-free survival (TFS), measured from date of treatment to date of recurrence or initiation of additional salvage treatment, using Kaplan–Meier plots. Complications were reported using the Clavien–Dindo (CD) scale. Overall 1-year and 5-year RFS were 76.0% and 25.1%, and overall 1-year and 5-year TFS were 91.5% and 58.2%, respectively. Patients without prior RP showed a significantly higher 1-year (78.5% vs. 52.5%) and 5-year RFS (28.1% vs. 0.0%;p= 0.03), and a trend towards a higher 1-year (92.6% vs. 79.0%) and 5-year TFS (60.2% vs. 23.0%;p= 0.10) compared to those with prior RP. A total of 46 complications occurred in 37 patients, and the overall complication rate was 32.4% (37/114 patients). The majority (41/46; 89.1%) of complications were minor (CD 1–2). Overall (31.3 vs. 40.0%) and major (3.0 vs. 13.3%) complication rates were lower in patients without compared to those with prior RP, respectively. MRI-guided SFC is an effective and safe therapy for patients with recurrent PCa, and has proved to delay and potentially prevent the initiation of salvage treatments. Patients with locally recurrent PCa after prior RP had an increased risk of recurrence, a shortened time to additional treatment, and more complications compared to those without prior RP, which should be considered when selecting patients for SFC.
局限性复发性前列腺癌患者可选择雄激素剥夺疗法、挽救性根治性前列腺切除术或放射治疗。这些治疗方法常伴随严重副作用，凸显了对低并发症率替代性局部治疗方案的需求。本研究纳入了2011年至2021年间所有接受磁共振成像引导下挽救性局灶冷冻消融治疗的局限性复发性前列腺癌患者（n=114），并分为两个亚组：无既往前列腺切除术史患者（n=99）与有既往前列腺切除术史患者（n=15）。通过Kaplan-Meier曲线评估从治疗日至复发或启动额外挽救性治疗日期间的复发无进展生存期和治疗无干预生存期。并发症采用Clavien-Dindo分级系统进行报告。总体1年及5年复发无进展生存率分别为76.0%和25.1%，总体1年及5年治疗无干预生存率分别为91.5%和58.2%。与有既往前列腺切除术史患者相比，无既往手术史患者表现出显著更高的1年（78.5% vs. 52.5%）和5年复发无进展生存率（28.1% vs. 0.0%；p=0.03），其1年（92.6% vs. 79.0%）和5年治疗无干预生存率（60.2% vs. 23.0%；p=0.10）亦呈现更高趋势。37例患者共发生46例并发症，总体并发症发生率为32.4%（37/114）。绝大多数并发症（41/46；89.1%）为轻微并发症（CD 1-2级）。无既往前列腺切除术史患者的总体并发症发生率（31.3% vs. 40.0%）及严重并发症发生率（3.0% vs. 13.3%）均低于有既往手术史患者。磁共振成像引导下挽救性局灶冷冻消融术是治疗复发性前列腺癌有效且安全的疗法，可延缓并可能避免启动挽救性治疗。与无既往前列腺切除术史患者相比，既往接受过前列腺切除术的局部复发性前列腺癌患者具有更高的复发风险、更短的额外治疗启动时间及更多并发症，在选择挽救性局灶冷冻消融术治疗对象时应予以充分考虑。
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