膀胱下梗阻解除及高强度聚焦超声治疗局限性前列腺癌后的生活质量和功能结局
Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer.
作者信息
Hatiboglu G, Popeneciu I V, Deppert M, Nyarangi-Dix J, Hadaschik B, Hohenfellner M, Teber D, Pahernik S
机构信息
Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
出版信息
BMC Urol. 2017 Jan 11;17(1):5. doi: 10.1186/s12894-017-0198-2.
BACKGROUND
To evaluate quality of life, functional and oncological outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer.
METHODS
One hundred thirty-one patients, treated with TURP and HIFU in a single institution were followed up for oncological and functional outcome. Oncological outcome was quantified by biochemical recurrence free survival using the Stuttgart and Phoenix criteria. Quality of life was assessed by usage of standardized QLQ-C30 and QLQ-PR25 questionnaires. In addition, functional questionnaires such as IPSS and IIEF-5 were used. Complications were assessed by the Clavien-Dindo classification.
RESULTS
One hundred thirty-one patients with a mean age of 72.8 years (SD: 6.0) underwent HIFU for prostate cancer (29.0% low risk, 58.8% intermediate risk, 12.2% high risk). PSA nadir was 0.6 ng/ml (SD: 1.2) after a mean of 4.6 months (SD: 5.7). Biochemical recurrence free survival defined by Stuttgart criteria was 73.7%, 84.4% and 62.5% for low-, intermediate- and high-risk patients after 22.2 months. Complications were grouped according to Clavien-Dindo and occurred in 10.7% (grade II) and 11.5% (grade IIIa) of cases. 35.1% of patients needed further treatment for bladder neck stricture. Regarding incontinence, 14.3%, 2.9% and 0% of patients had de novo urinary incontinence grade I°, II° and III° and 3.8% urge incontinence due to HIFU treatment. Patients were asked for the ability to have intercourse: 15.8%, 58.6% and 66.7% of patients after non-, onesided and bothsided nervesparing procedure were able to obtain sufficient erection for intercourse, respectively. Regarding quality of life, mean global health score according to QLQ-C30 was 69.4%.
CONCLUSION
HIFU treatment for localized prostate cancer shows acceptable oncological safety. Quality of life after HIFU is better than in the general population and ranges within those of standard treatment options compared to literature. HIFU seems a safe valuable treatment alternative for patients not suitable for standard treatment.
背景
评估膀胱下解除梗阻及高强度聚焦超声（HIFU）治疗局限性前列腺癌后的生活质量、功能及肿瘤学结局。
方法
对在单一机构接受经尿道前列腺电切术（TURP）和HIFU治疗的131例患者进行肿瘤学和功能结局随访。采用斯图加特和凤凰城标准通过无生化复发生存期对肿瘤学结局进行量化。使用标准化的QLQ-C30和QLQ-PR25问卷评估生活质量。此外，还使用了国际前列腺症状评分（IPSS）和国际勃起功能指数-5（IIEF-5）等功能问卷。通过Clavien-Dindo分类评估并发症。
结果
131例平均年龄72.8岁（标准差：6.0）的患者接受了前列腺癌HIFU治疗（低风险29.0%，中风险58.8%，高风险12.2%）。平均4.6个月（标准差：5.7）后前列腺特异性抗原（PSA）最低点为0.6 ng/ml（标准差：1.2）。按照斯图加特标准定义，低、中、高风险患者在22.2个月后的无生化复发生存期分别为73.7%、84.4%和62.5%。并发症根据Clavien-Dindo分类，分别在10.7%（Ⅱ级）和11.5%（Ⅲa级）的病例中发生。35.1%的患者因膀胱颈狭窄需要进一步治疗。关于尿失禁，14.3%、2.9%和0%的患者分别出现了新发性Ⅰ°、Ⅱ°和Ⅲ°尿失禁，3.8%的患者因HIFU治疗出现急迫性尿失禁。询问患者的性交能力：未行神经保留、单侧神经保留和双侧神经保留手术后分别有15.8%、58.6%和66.7%的患者能够获得足够的勃起进行性交。关于生活质量，根据QLQ-C30的平均总体健康评分为69.4%。
结论
HIFU治疗局限性前列腺癌显示出可接受的肿瘤学安全性。与一般人群相比，HIFU治疗后的生活质量更好，与文献报道的标准治疗方案范围内的生活质量相当。对于不适合标准治疗的患者，HIFU似乎是一种安全且有价值的治疗选择。
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