Department of Urology, Centre Hospitalier Regional Universitaire de Lille, Lille, France.
Urol Oncol. 2013 Feb;31(2):155-67. doi: 10.1016/j.urolonc.2012.05.011. Epub 2012 Jul 12.
Over the last years, focal therapy has emerged as an intermediate management technique between radical approaches (radical prostatectomy, external beam radiation, and brachytherapy) and watchful waiting to manage some early stage prostate cancers (CaP). Different energy modalities are being developed. The aim of this study is to review these energy modalities and their indications.
We reviewed the literature to concentrate on the practical aspects of focal therapy for CaP with the following key words: photodynamic therapy, high intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation, electroporation, radio frequency, external beam radiation, organ-sparing approach, focal therapy, CaP, and then by cross-referencing from previously identified studies.
Prostatic tumor ablation can be achieved with different energies: freezing effect for cryotherapy, thermal effect using focalized ultrasound for HIFU, and using thermal effect of light for focal laser ablation (FLA) and activation of a photosensitizer by light for PDT, among others. Radio frequency and microwave therapy have been tested in this field and demonstrated their usefulness. Electroporation is currently being developed on preclinical models. External beam radiation with microboost on neoplastic foci is under evaluation. HIFU and cryotherapy require the use of sophisticated and expensive machines and, consequently, the procedure is expensive. Laser techniques seem to be less onerous, with the added advantage of size.
Several energy modalities are being developed to achieve the trifecta of continence, potency, and oncologic efficiency. Those techniques come with low morbidity but clinical experience is limited regarding to oncologic outcome. Comparison of the different focal approaches is complex owing to important heterogeneity of the trials. In the future, it seems likely that each technique will have its own selective indications.
近年来，聚焦治疗作为一种介于根治性方法（前列腺根治切除术、外束放射治疗和近距离放射治疗）和观察等待之间的中间管理技术，已被用于治疗某些早期前列腺癌（CaP）。不同的能量模式正在被开发。本研究旨在回顾这些能量模式及其适应证。
我们查阅了文献，重点关注前列腺癌聚焦治疗的实际方面，使用了以下关键词：光动力疗法、高强度聚焦超声（HIFU）、冷冻疗法、聚焦激光消融、电穿孔、射频、外束放射治疗、保留器官方法、聚焦治疗、CaP，然后通过交叉引用先前确定的研究进行交叉引用。
不同的能量可以实现前列腺肿瘤消融：冷冻疗法的冷冻效应、HIFU 的聚焦超声的热效应、以及光的热效应用于 FLA 和光激活光敏剂的 PDT 等。射频和微波治疗已在该领域进行了测试并证明了其有用性。电穿孔目前正在临床前模型中开发。在肿瘤焦点上使用微升压的外束放射治疗正在评估中。HIFU 和冷冻疗法需要使用复杂且昂贵的机器，因此，该程序费用昂贵。激光技术似乎负担较小，并且具有尺寸的优势。
为了实现控尿、勃起功能和肿瘤效率的三效，正在开发几种能量模式。这些技术具有低发病率，但关于肿瘤学结果的临床经验有限。由于试验的重要异质性，不同的聚焦方法之间的比较很复杂。在未来，每种技术似乎都可能有其自身的选择性适应证。
