Department of Urology, Weill Cornell Medical College, New York, New York.
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
J Urol. 2017 Nov;198(5):1000-1009. doi: 10.1016/j.juro.2017.03.137. Epub 2017 Apr 19.
Advances in prostate imaging, biopsy and ablative technologies have been accompanied by growing enthusiasm for partial gland ablation, particularly using high-intensity focused ultrasound, to treat prostate cancer. Preserving noncancerous prostate tissue and minimizing damage to the neurovascular bundles and external urethral sphincter may improve functional outcomes.
A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a combination of MeSH® terms, free text search and examination of relevant bibliographies using MEDLINE® and Embase® from the inception of each database through October 10, 2016. We excluded studies describing exclusively whole gland ablation, case reports and series where treatment was followed by immediate resection.
A total of 13 studies that enrolled 543 patients were included. Of the studies 11 were performed in the primary setting and 2 in the salvage setting. Median followup ranged from 6 months to 10.6 years. Rates of posttreatment erectile dysfunction and urinary incontinence ranged from 0% to 48% and 0% to 50%, respectively, with definitions varying by study. Overall there were 254 reported complications. Marked heterogeneity between studies limited the ability to pool results regarding functional and oncologic outcomes. A total of 76 patients (14%) subsequently received further oncologic treatment.
Early evidence suggests that partial gland ablation is a safe treatment option for men with localized disease. Longer term data are needed to evaluate oncologic efficacy and functional outcomes, and will aid in identifying the optimal candidates for therapy. Standardization of outcomes definitions will allow for better comparison between studies and among treatment modalities.
前列腺影像学、活检和消融技术的进步伴随着部分腺体消融术的日益普及，尤其是高强度聚焦超声技术，用于治疗前列腺癌。保留非癌性前列腺组织并最大程度地减少对神经血管束和尿道外括约肌的损伤可能会改善功能结果。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用 MEDLINE®和 Embase®中的 MeSH®术语、自由文本搜索以及对每个数据库的相关参考文献的检查，对从数据库建立到 2016 年 10 月 10 日的文献进行了系统回顾。我们排除了仅描述整个腺体消融术、病例报告和治疗后立即进行切除的系列研究。
共纳入了 13 项研究，共纳入了 543 名患者。其中 11 项研究在初级治疗中进行，2 项在挽救性治疗中进行。中位随访时间从 6 个月到 10.6 年不等。治疗后勃起功能障碍和尿失禁的发生率分别为 0%至 48%和 0%至 50%，具体定义因研究而异。总的来说，有 254 例报告的并发症。研究之间存在显著的异质性，限制了对功能和肿瘤学结果进行汇总的能力。共有 76 名患者（14%）随后接受了进一步的肿瘤治疗。
早期证据表明，部分腺体消融术是治疗局限性疾病男性的安全治疗选择。需要长期数据来评估肿瘤学疗效和功能结果，并有助于确定治疗的最佳候选者。对结果定义的标准化将允许更好地比较研究之间以及治疗方式之间的差异。
