Albisinni Simone, Aoun Fouad, Bellucci Simon, Biaou Ibrahim, Limani Ksenija, Hawaux Eric, Peltier Alexandre, van Velthoven Roland
Urology Department, Jules Bordet Institute, Université libre de Bruxelles , Brussels, Belgium .
J Endourol. 2017 Jan;31(1):14-19. doi: 10.1089/end.2016.0702. Epub 2016 Nov 30.
Although still experimental, focal treatment is being increasingly implemented in the management of prostate cancer (PCa). Aim of the current study was to compare functional and oncologic outcomes of high-intensity focal ultrasound (HIFU) hemiablation of the prostate to robot-assisted laparoscopic prostatectomy (RALP) in the management of unilateral PCa.
Fifty-five men with unilateral, clinically localized PCa underwent HIFU hemiablation of the affected prostatic lobe between 2007 and 2015. All patients were found to have unilateral disease on the basis on full concordance between multiparametric magnetic resonance imaging (MRI) and MRI-guided biopsies. These patients were matched 1:1 with patients who underwent RALP for PCa in which pT2a-b disease (unilateral) was found on final pathologic analysis. Matching criteria were Gleason score, prostate specific antigen (PSA), and cT stage. Treatment failure was defined as the need for salvage external beam radiotherapy or systemic androgen deprivation therapy (ADT) due to disease progression. Kaplan-Meier curves and log-rank tests were constructed to assess differences in salvage treatment free survival across surgical techniques.
Matching was effective with no significant differences across the two groups, although men treated with HIFU were older (p < 0.001). Median follow-up was 36 months (interquartile range 16-56). HIFU was associated to better and faster recovery of continence, with most men (82%) showing no signs of urinary incontinence even right after surgery. Moreover, the risk of de novo erectile dysfunction was significantly lower after HIFU. No significant difference was found in the need for salvage external beam radiation therapy or ADT across the two surgical approaches: 7/55 men underwent salvage therapy in the HIFU vs 6/55 in the RALP group (p = 0.76). Nonetheless, seven more patients in the HIFU arm required a complementary treatment on the contralateral lobe during follow-up, after developing a contralateral PCa. No patient died of PCa on follow-up, while six men died of other causes (five HIFU vs one RALP, p = 0.11).
In this matched pair analysis, HIFU hemiablation was comparable to RALP in controlling localized unilateral PCa, with no significant differences in the need for salvage therapies. HIFU was also associated to significantly better functional outcomes. Accurate patient selection remains vital, and larger prospective trials are needed to confirm our findings.
尽管聚焦治疗仍处于实验阶段，但在前列腺癌（PCa）的管理中应用越来越广泛。本研究的目的是比较高强度聚焦超声（HIFU）前列腺半消融术与机器人辅助腹腔镜前列腺切除术（RALP）在单侧PCa治疗中的功能和肿瘤学结果。
2007年至2015年期间，55例单侧临床局限性PCa患者接受了患侧前列腺叶的HIFU半消融术。根据多参数磁共振成像（MRI）和MRI引导活检的完全一致性，所有患者均被发现患有单侧疾病。这些患者与因PCa接受RALP治疗且最终病理分析发现为pT2a - b期（单侧）疾病的患者按1:1匹配。匹配标准为Gleason评分、前列腺特异性抗原（PSA）和cT分期。治疗失败定义为因疾病进展需要挽救性外照射放疗或全身雄激素剥夺治疗（ADT）。构建Kaplan - Meier曲线和对数秩检验以评估不同手术技术在无挽救治疗生存期方面的差异。
匹配有效，两组之间无显著差异，尽管接受HIFU治疗的男性年龄较大（p < 0.001）。中位随访时间为36个月（四分位间距16 - 56个月）。HIFU与更好、更快的控尿恢复相关，大多数男性（82%）即使在手术后立即也没有尿失禁迹象。此外，HIFU后新发勃起功能障碍的风险显著更低。两种手术方法在挽救性外照射放疗或ADT需求方面未发现显著差异：HIFU组55例中有7例接受了挽救治疗，RALP组55例中有6例（p = 0.76）。然而，HIFU组有7例患者在随访期间对侧发生PCa后需要对侧叶进行补充治疗。随访期间无患者死于PCa，6例男性死于其他原因（HIFU组5例，RALP组1例，p = 0.11）。
在这项配对分析中，HIFU半消融术在控制局限性单侧PCa方面与RALP相当，在挽救治疗需求方面无显著差异。HIFU还与显著更好的功能结果相关。准确的患者选择仍然至关重要，需要更大规模的前瞻性试验来证实我们的发现。
