Division of Surgery and Interventional Sciences, University College London, UK.
Clin Oncol (R Coll Radiol). 2013 Aug;25(8):461-73. doi: 10.1016/j.clon.2013.05.002. Epub 2013 Jun 4.
Focal therapy is an emerging treatment modality for localised prostate cancer that aims to reduce the morbidity seen with radical therapy, while maintaining cancer control. Focal therapy treatment strategies minimise damage to non-cancerous tissue, with priority given to the sparing of key structures such as the neurovascular bundles, external sphincter, bladder neck and rectum. There are a number of ablative technologies that can deliver energy to destroy cancer cells as part of a focal therapy strategy. The most widely investigated are cryotherapy and high-intensity focussed ultrasound. Existing radical therapies, such as brachytherapy and external beam radiotherapy, also have the potential to be applied in a focal manner. The functional outcomes of focal therapy from several phase I and II trials have been encouraging, with low rates of urinary incontinence and erectile dysfunction. Robust medium- and long-term cancer control outcomes are currently lacking. Controversies in focal therapy remain, notably treatment paradigms based on the index lesion hypothesis, appropriate patient selection for focal therapy and how the efficacy of focal therapy should be assessed. This review articles discusses the current status of focal therapy, highlighting controversies and emerging strategies that can influence treatment outcomes for the future.
聚焦治疗是一种针对局限性前列腺癌的新兴治疗方法，旨在降低根治性治疗带来的发病率，同时保持癌症控制。聚焦治疗策略最大限度地减少对非癌组织的损伤，优先保护关键结构，如神经血管束、外括约肌、膀胱颈部和直肠。有许多消融技术可以输送能量来破坏癌细胞，作为聚焦治疗策略的一部分。研究最多的是冷冻疗法和高强度聚焦超声。现有的根治性治疗方法，如近距离放射治疗和外照射放射治疗，也有可能以聚焦方式应用。来自几项 I 期和 II 期试验的聚焦治疗的功能结果令人鼓舞，尿失禁和勃起功能障碍的发生率较低。目前缺乏强有力的中期和长期癌症控制结果。聚焦治疗仍存在争议，特别是基于病灶假说的治疗模式、聚焦治疗的合适患者选择以及如何评估聚焦治疗的疗效。这篇综述文章讨论了聚焦治疗的现状，强调了争议和新出现的策略，这些策略可能会影响未来的治疗结果。
