Ward John F, Nakanishi Hiroyuki, Pisters Louis, Babaian R Joseph, Troncoso Patricia
Department of Urology, The University of Texas M D Anderson Cancer Center, Houston, TX 77230-1439, USA.
BJU Int. 2009 Aug;104(4):490-7. doi: 10.1111/j.1464-410X.2009.08359.x. Epub 2009 Feb 10.
To assess the totality of prostate cancer eradication in radical prostatectomy (RP) specimens from men with a unilaterally positive prostate biopsy, and who would currently qualify for subtotal prostate ablation with controlled thermal energy such as cryoablation or high-intensity focused ultrasound.
Therapies for prostate cancer hold the promise of individualized treatment that selectively ablates the tumour while minimizing treatment-associated morbidity, but as prostate cancer is multifocal there are concerns about untreated residual disease. RP specimens (180) from men with a unilaterally positive prostate biopsy were examined to characterize the location, volume and grade of each tumour focus. Two treatment templates (hemiprostate and 'hockey-stick') were applied to every prostate cross-section. The nature of the in-field and out-of-field tumours was assessed and described for each treatment template.
A single focus of cancer was the only tumour in 31 (17%) of the patients (contralateral cancer was present in 149, 83%, of specimens despite a unilateral positive biopsy). Hemiprostate and hockey-stick treatment templates covered all tumour foci in 17% and 47% of men, respectively. Most out-of-field cancers were clinically insignificant tumours not identified by prostate biopsy (low-volume, 0.5 mL; and low grade, Gleason score < or =6). Regional ablation would have successfully treated all clinically significant prostate tumours in 64% and 81% of patients using the hemiprostate or hockey-stick template, respectively. The hockey-stick template encompassed all dominant tumours (largest volume).
Regionally targeted prostate ablation is capable of eradicating all dominant tumours and the vast majority of clinically significant tumours in men with unilateral disease by biopsy. The study of focally ablative therapy should proceed under the auspices of an approved protocol.
评估单侧前列腺活检呈阳性、目前符合采用可控热能进行次全前列腺消融（如冷冻消融或高强度聚焦超声）的男性患者，其根治性前列腺切除术（RP）标本中前列腺癌的根除情况。
前列腺癌治疗有望实现个体化治疗，即选择性消融肿瘤同时将治疗相关发病率降至最低，但由于前列腺癌具有多灶性，人们担心存在未治疗的残留疾病。对单侧前列腺活检呈阳性的男性患者的RP标本（180份）进行检查，以确定每个肿瘤病灶的位置、体积和分级。将两种治疗模板（半侧前列腺和“曲棍球棒”）应用于每个前列腺横截面。评估并描述每种治疗模板的靶区内和靶区外肿瘤的性质。
31名（17%）患者的标本中仅存在单个癌灶（尽管单侧活检呈阳性，但149份标本，83%，对侧存在癌症）。半侧前列腺和曲棍球棒治疗模板分别覆盖了17%和47%男性患者的所有肿瘤病灶。大多数靶区外癌症是前列腺活检未发现的临床意义不大的肿瘤（体积小，0.5 mL；分级低，Gleason评分≤6）。分别使用半侧前列腺或曲棍球棒模板，区域消融可成功治疗64%和81%患者的所有具有临床意义的前列腺肿瘤。曲棍球棒模板涵盖了所有主要肿瘤（最大体积）。
区域靶向前列腺消融能够根除经活检确诊的单侧疾病男性患者的所有主要肿瘤以及绝大多数具有临床意义的肿瘤。聚焦消融治疗的研究应在获批方案的支持下进行。
