局限性前列腺癌的聚焦冷冻疗法

Focal Cryotherapy for Localized Prostate Cancer.

作者信息

Tay K J, Polascik T J

机构信息

Division of Urology. Department of Surgery. Duke University. Durham. North Carolina. United States of America.

出版信息

Arch Esp Urol. 2016 Jul;69(6):317-26.

PMID:27416635

Abstract

OBJECTIVE

To systematically review the oncological and functional outcomes of contemporary primary prostate focal cryotherapy for localized prostate cancer in the context of current developments in prostate focal therapy.

METHODS

We performed a systematic search of the Pubmed, Cochrane and Embase databases to identify studies where primary prostate focal cryotherapy was performed to treat prostate cancer. These included reports on focal/ lesion/ sector ablation, hemi-ablation and partial prostate ablation. We excluded salvage focal therapy studies. Where multiple reports were published over time from a single cohort, the latest one was used.

RESULTS

Our search yielded 290 publications, including 17 primary reports on eight single-center cohort studies and one multi-center registry report. Of 1,595 men identified, mean age was 60.5-69.5 years and mean PSA 5.1-7.8 ng/ml. When stratified by D'Amico risk criteria, 52% of the aggregate total number of men were low-risk, 38% intermediate-risk and 10% high-risk. Besides 12-core TRUS biopsy, 3 cohorts reported using TTMB and one included mpMRI to select men for focal treatment. Median follow-up ranged from 13-63 months. BPFS ranged from 71-98%. The overall post-treatment positive biopsy rate was 8-25%. Among 5 cohorts with a mandatory 6-12 month posttreatment biopsy, 216 of 272 men (79%) did undergo biopsy, with 47 positive (21.8%). Of these, 15 were infield, 26 outfield, 2 bilateral and 4 undeclared. Ten upgraded to Gleason≥7. Overall, two men had metastatic disease and none died of prostate cancer. Post-treatment continence rates were 96-100% and rates of erectile dysfunction ranged from 0-42%. The rate of post-treatment urinary retention ranged from 0-15%. The rate of recto-urethral fistula was 0-0.1%.

CONCLUSION

Focal cryotherapy for localized prostate cancer is a safe and provides good preservation of sexual and urinary function. Accurate cancer localization and risk stratification is key to patient selection. In highly selected patients, focal therapy has good short to medium term oncological efficacy.

摘要

目的

在前列腺聚焦治疗当前发展的背景下，系统回顾当代原发性前列腺聚焦冷冻疗法治疗局限性前列腺癌的肿瘤学和功能学结果。

方法

我们对PubMed、Cochrane和Embase数据库进行了系统检索，以识别进行原发性前列腺聚焦冷冻疗法治疗前列腺癌的研究。这些研究包括关于局灶性/病变/扇形消融、半消融和部分前列腺消融的报告。我们排除了挽救性聚焦治疗研究。如果同一队列随时间发表了多篇报告，则使用最新的一篇。

结果

我们的检索产生了290篇出版物，包括关于八项单中心队列研究的17篇主要报告和一篇多中心登记报告。在确定的1595名男性中，平均年龄为60.5 - 69.5岁，平均前列腺特异性抗原（PSA）为5.1 - 7.8 ng/ml。根据达米科风险标准分层时，男性总数中52%为低风险，38%为中风险，10%为高风险。除了12针经直肠超声引导下活检外，3个队列报告使用了靶向组织活检（TTMB），1个队列纳入了多参数磁共振成像（mpMRI）来选择进行聚焦治疗的男性。中位随访时间为13 - 63个月。生化无进展生存率（BPFS）为71% - 98%。总体治疗后活检阳性率为8% - 25%。在5个强制要求治疗后6 - 12个月进行活检的队列中，272名男性中有216名（79%）接受了活检，其中47名阳性（21.8%）。其中，15例为瘤内，26例为瘤外，2例为双侧，4例未明确。10例升级为Gleason评分≥7。总体而言，两名男性出现转移性疾病，无男性死于前列腺癌。治疗后尿失禁发生率为96% - 100%，勃起功能障碍发生率为0% - 42%。治疗后尿潴留发生率为0% - 15%。直肠尿道瘘发生率为0% - 0.1%。