Department of Urology, Smilow Comprehensive Prostate Cancer Center, New York University School of Medicine, New York, NY, USA.
Department of Urology, Smilow Comprehensive Prostate Cancer Center, New York University School of Medicine, New York, NY, USA.
Eur Urol. 2015 Dec;68(6):924-6. doi: 10.1016/j.eururo.2015.04.029. Epub 2015 Jun 5.
From April 2013 to July 2014, 25 consecutive men participated in a longitudinal outcomes study following in-bore magnetic resonance imaging (MRI)-guided focal laser ablation (FLA) of prostate cancer (PCa). Eligibility criteria were clinical stage T1c and T2a disease; prostate-specific antigen (PSA) <10 ng/ml; Gleason score <8; and cancer-suspicious regions (CSRs) on multiparametric MRI harboring PCa. CSRs harboring PCa were ablated using a Visualase cooled laser applicator system. Tissue temperature was monitored throughout the ablation cycle by proton resonance frequency shift magnetic resonance thermometry from phase-sensitive images. There were no significant differences between baseline and 3-mo mean American Urological Association Symptom Score or Sexual Health Inventory in Men scores. No man required pads at any time. Overall, the mean PSA decrease between baseline and 3 mo was 2.3 ng/ml (44.2%). Of 28 sites subjected to target biopsy after FLA, 26 (96%) showed no evidence of PCa. Our study provides encouraging evidence that excellent early oncologic control of significant PCa can be achieved following FLA, with virtually no complications or adverse impact on quality of life. Longer follow-up is required to show that oncologic control is durable.
Early results for focal laser ablation of prostate cancer are very encouraging. Until long-term oncologic control is demonstrated, focal laser ablation must be considered an investigational treatment option.
从 2013 年 4 月到 2014 年 7 月，25 名连续男性参与了一项纵向结果研究，该研究在管内磁共振成像（MRI）引导下对前列腺癌（PCa）进行了聚焦激光消融（FLA）。入选标准为临床分期 T1c 和 T2a 疾病；前列腺特异性抗原（PSA）<10ng/ml；格里森评分<8；多参数 MRI 上有可疑癌症区域（CSR）存在 PCa。使用 Visualase 冷却激光应用器系统对含有 PCa 的 CSR 进行消融。通过从相敏图像中质子共振频率偏移磁共振测温，在整个消融周期中监测组织温度。在基线和 3 个月的平均美国泌尿外科学会症状评分或男性健康问卷评分方面，没有显著差异。没有男人在任何时候都需要使用尿垫。总的来说，在基线和 3 个月之间 PSA 的平均下降值为 2.3ng/ml（44.2%）。在 FLA 后进行的 28 个目标活检部位中，26 个（96%）没有发现 PCa 的证据。我们的研究提供了令人鼓舞的证据，表明在 FLA 后可以实现对显著 PCa 的极好的早期肿瘤控制，几乎没有并发症或对生活质量产生不利影响。需要更长的随访时间来证明肿瘤控制是持久的。
聚焦激光消融前列腺癌的早期结果非常令人鼓舞。在证明长期肿瘤控制之前，聚焦激光消融必须被视为一种研究性治疗选择。
