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Clinical value of normal saline injection for expansion of the anterior perirectal space during prostate cryoablation

  • Author Footnotes
    1 These authors contributed equally to this work.
    Ning Wang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Di-wei Zhao
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Dong Chen
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Zhi-ming Wu
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Yan-jun Wang
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Zhen-yu Yang
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Jun-liang Zhao
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
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  • Fang-jian Zhou
    Correspondence
    Corresponding author. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China.
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Yong-hong Li
    Correspondence
    Corresponding author. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China.
    Affiliations
    State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China

    Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Abstract

      Background

      The objective of this study is to describe the technique and evaluate the clinical value of normal saline (NS) injection for expanding the anterior perirectal space during prostate cryoablation for prostate cancer (PCa) patients.

      Methods

      PCa patients who received cryoablation between August 2014 and December 2019 were enrolled, and the technique of NS injection was adopted. The complications were evaluated. The prostate-specific antigen (PSA) nadir and biochemical progression-free survival (bPFS) were measured in localized PCa patients who received cryoablation as the primary treatment.

      Results

      A total of 159 PCa patients were included. Among 147 patients with the data of anterior perirectal space, the median (interquartile range [IQR]) distance of estimated iceball edge beyond the prostatic capsule was 8.3 (7.0–10.0) mm. No cases of urethrorectal fistula were reported; 29 patients developed urinary retention and 25 patients presented scrotal edema. All complications below Clavien-Dindo grade IIIb disappeared within 7 weeks after surgery. Urinary incontinence was reported in 6 patients. Among localized PCa patients, the median (IQR) follow-up time was 56.5 (36.0–73.5) months. The estimated 5-year bPFS was 82.3% overall, 82.8% for low-to intermediate-risk PCa patients, and 82.1% for high-risk PCa patients. For 52 patients received cryoablation alone, the median (IQR) PSA nadir was 0.147 (0.027–0.381) ng/mL.

      Conclusions

      The technique of NS injection for expanding the anterior perirectal space during cryoablation surgery could avoid urethrorectal fistula and might benefit localized PCa patients with lower PSA nadir and longer bPFS.

      Keywords

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