Division of Urology, Duke University, Durham, NC, USA.
Department of Urology, Singapore General Hospital, SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore.
World J Urol. 2019 Mar;37(3):397-407. doi: 10.1007/s00345-018-2363-y. Epub 2018 Jun 9.
Long-term outcomes from large cohorts are not yet available upon which to base recommended follow-up protocols after prostate focal therapy. This is an updated summary of a 2015 SIU-ICUD review of the best available current evidence and expert consensus on guidelines for surveillance after prostate focal therapy.
We performed a systematic search of the PubMed, Cochrane and Embase databases to identify studies where primary prostate focal therapy was performed to treat prostate cancer.
Multiparametric magnetic resonance imaging (mpMRI) should be performed at 3-6 months, 12-24 months and at 5 years after focal therapy. Targeted biopsy of the treated zone should be performed at 3-6 months and fusion biopsy of any suspicious lesion seen on mpMRI. Additionally, a systematic biopsy should be performed at 12-24 months and again at 5 years. In histological diagnosis, characteristic changes of each treatment modality should be noted and in indeterminate situations various immunohistochemical molecular markers can be helpful. Small volume 3 + 3 (Prognostic grade group [PGG] 1) or very small volume (< 0.2 cc or < 7 mm diameter) 3 + 4 (PGG 2) are acceptable in the treated zone at longitudinal follow-up. Significant volumes of 3 + 4 (PGG 2) or more within the treated zone should be treated. Any clinically significant cancer subsequently arising within the non-treated zone should be treated and handled in the same way as any de novo prostate cancer. Patients should be counseled regarding whole-gland and focal approaches to treating these new foci where appropriate. One or two well-delineated foci of significant cancer can be ablated to keep the patient in the 'active surveillance pool'. More extensive disease should be treated with traditional whole-gland techniques.
Focal therapy remains a nascent field largely comprising single center cohorts with little long-term data. Our current post-focal therapy surveillance consensus recommendations represent the synthesis of the best available evidence as well as expert opinion. Further work is necessary to define the most oncologically safe and cost-effective way of following patients after focal therapy.
在前列腺局灶性治疗后，基于长期的队列研究结果，尚未建立推荐的随访方案。这是 2015 年 SIU-ICUD 对前列腺局灶性治疗后监测指南的最佳现有证据和专家共识进行的更新总结。
我们对 PubMed、Cochrane 和 Embase 数据库进行了系统检索，以确定对原发性前列腺局灶性治疗前列腺癌的研究。
前列腺局灶性治疗后，应在 3-6 个月、12-24 个月和 5 年时进行多参数磁共振成像（mpMRI）检查。应在 3-6 个月时对治疗区域进行靶向活检，并对 mpMRI 上发现的任何可疑病变进行融合活检。此外，应在 12-24 个月和 5 年时进行系统活检。在组织学诊断中，应注意每种治疗方式的特征性变化，在不确定的情况下，各种免疫组织化学分子标志物可能会有所帮助。在纵向随访中，治疗区域内的小体积 3+3（预后分级组[PGG] 1）或非常小体积（<0.2cc 或<7mm 直径）3+4（PGG 2）是可以接受的。治疗区域内的大体积 3+4（PGG 2）或更多的需要进行治疗。在非治疗区域内新出现的任何有临床意义的癌症都应进行治疗，并以与新发前列腺癌相同的方式进行处理。应根据需要向患者提供治疗这些新病灶的全腺和局灶方法的咨询。对于可以用单一、清晰的治疗方法控制的 1-2 个有显著意义的肿瘤焦点，可以将患者保留在“主动监测池”中。更广泛的疾病应采用传统的全腺治疗技术。
前列腺局灶性治疗仍然是一个新兴领域，主要包括单中心队列研究，长期数据较少。我们目前的前列腺局灶性治疗后监测共识建议代表了最佳现有证据以及专家意见的综合。进一步的工作对于确定在前列腺局灶性治疗后对患者进行随访的最具肿瘤安全性和成本效益的方法是必要的。
