Shah Taimur T, Kasivisvanathan Veeru, Jameson Charles, Freeman Alex, Emberton Mark, Ahmed Hashim U
Division of Surgery and Interventional Science, Urology Research Group, UCL, Room 4.23, 4th Floor, 132 Hampstead Road, London, NW1 2PS, UK,
World J Urol. 2015 Jul;33(7):955-64. doi: 10.1007/s00345-015-1561-0. Epub 2015 May 6.
Focal therapy has increasingly become an accepted treatment option for patients with localised prostate cancer. Most follow-up protocols use a mixture of protocol biopsies or "for cause" biopsies triggered by a rising PSA. In this paper, we discuss the histological outcomes from these biopsies and their use in guiding subsequent management and trial development.
We conducted a literature search and reviewed the post-treatment biopsy results from studies on focal HIFU and focal cryotherapy. We subsequently reviewed the results of three recently published consensus statements released discussing many of the issues concerning focal therapy.
Research suggests that 1 in 5 of all post-treatment biopsies after focal therapy are positive. However, the majority of these seemed to be from the untreated portion of the gland or met criteria for clinically insignificant disease. The histological outcomes from focal therapy are promising and confirm its effectiveness in the short to medium term. Furthermore re-treatment is possible whilst maintaining a low-side-effect profile.
Debate is ongoing about the clinical significance of various levels of residual disease after focal therapy and the exact threshold at which to call failure within a patient who has had focal therapy.
聚焦治疗已日益成为局限性前列腺癌患者可接受的治疗选择。大多数随访方案采用方案活检或由前列腺特异抗原（PSA）升高引发的“因症”活检相结合的方式。在本文中，我们讨论这些活检的组织学结果及其在指导后续管理和试验开展中的应用。
我们进行了文献检索，并回顾了聚焦高强度聚焦超声（HIFU）和聚焦冷冻治疗研究的治疗后活检结果。随后，我们回顾了最近发布的三份共识声明的结果，这些声明讨论了许多与聚焦治疗相关的问题。
研究表明，聚焦治疗后所有治疗后活检中有五分之一呈阳性。然而，其中大多数似乎来自腺体未治疗的部分或符合临床意义不显著疾病的标准。聚焦治疗的组织学结果很有前景，并证实了其在短期至中期的有效性。此外，再次治疗是可行的，同时副作用较小。
关于聚焦治疗后不同程度残留疾病的临床意义以及在接受聚焦治疗的患者中判定失败的确切阈值，目前仍存在争议。
