Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany.
J Endourol. 2019 Feb;33(2):100-106. doi: 10.1089/end.2018.0468.
The aim of the study was to compare the oncological and functional outcomes in localized prostate cancer patients who received non-whole-gland high-intensity focused ultrasound (HIFU) with those in patients who received whole-gland HIFU therapy.
Eighty-six patients from September 2012 to January 2017 in our center were retrospectively analyzed. Oncological outcomes included histological absence of prostate cancer, biochemical disease-free survival (BDFS) as well as the absence of lesions suspected for harboring prostate cancer in multiparametric magnetic resonance imaging (mpMRI). Regarding functional outcomes, we determined international prostate symptom score (IPSS), pad-free rate, pad-free and leakage-free rates as well as international index of erectile function-5 (IIEF-5).
Of the 86 patients, 25 patients who underwent non-whole-gland HIFU and 61 patients who underwent whole-gland HIFU were enrolled in our 1-year follow-up study. There were no significant differences in histological absence of prostate cancer (p = 0.655), BDFS (p = 0.820), prostate-specific antigen (PSA) nadir (p = 0.453), and absence of suspicious lesions in mpMRI (p = 0.633) between non-whole-gland HIFU group and whole-gland HIFU group. However, compared with the whole-gland HIFU, the non-whole-gland HIFU group had fewer IPSS at 1 month (8.64 ± 3.63 vs 10.85 ± 6.10), a longer time to PSA nadir (5.04 ± 2.07 vs 3.83 ± 1.65), less temporary urine retention rate (20.0% vs 44.3%), less complication rate especially urinary tract strictures (4% vs 26.2%), whereas pad-free rate, pad-free and leakage-free rates, and IIEF scores were comparable.
Non-whole-gland HIFU is a promising type of treatment for localized prostate cancer with satisfactory oncological results with less impairment of functional outcomes and complications compared with whole-gland HIFU, but it requires longer follow-up and larger samples of randomized control trials.
本研究旨在比较接受非全腺体高强度聚焦超声（HIFU）治疗的局限性前列腺癌患者与接受全腺体 HIFU 治疗的患者的肿瘤学和功能结局。
我们回顾性分析了 2012 年 9 月至 2017 年 1 月在我中心接受治疗的 86 例患者。肿瘤学结局包括前列腺癌组织学无残留、生化无疾病生存（BDFS）以及多参数磁共振成像（mpMRI）中无可疑前列腺癌病灶。在功能结局方面，我们评估了国际前列腺症状评分（IPSS）、无尿垫率、无尿垫和无漏尿率以及国际勃起功能指数-5（IIEF-5）。
在 86 例患者中，25 例接受非全腺体 HIFU 治疗，61 例接受全腺体 HIFU 治疗，均纳入 1 年随访研究。非全腺体 HIFU 组和全腺体 HIFU 组在前列腺癌组织学无残留（p=0.655）、BDFS（p=0.820）、前列腺特异抗原（PSA）最低值（p=0.453）和 mpMRI 中无可疑病灶（p=0.633）方面无显著差异。然而，与全腺体 HIFU 相比，非全腺体 HIFU 组在 1 个月时的 IPSS 评分更低（8.64±3.63 对 10.85±6.10）、PSA 最低值时间更长（5.04±2.07 对 3.83±1.65）、暂时性尿潴留发生率更低（20.0%对 44.3%）、并发症发生率更低（尤其是尿路狭窄发生率更低，4%对 26.2%），但无尿垫率、无尿垫和无漏尿率以及 IIEF 评分相当。
与全腺体 HIFU 相比，非全腺体 HIFU 治疗局限性前列腺癌具有满意的肿瘤学结果，对功能结局的损害较小，并发症较少，但需要更长时间的随访和更大样本量的随机对照试验。
