Schostak M
Urologische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
Urologe A. 2019 May;58(5):518-523. doi: 10.1007/s00120-019-0862-0.
Focal therapy (FT) should have the same oncological efficacy as whole gland therapy with fewer side effects. Precise diagnosis with PI-RADS v2 standard multiparametric magnetic resonance imaging (MRI) and fusion or template biopsy is a basic prerequisite. Numerous ablation technologies and treatment strategies have been developed, including hemiablation. Treatment success is still inconsistently defined. The only large randomized study available compares one of the procedures to standard therapy. Therefore, even in 2019, FT must still be regarded as experimental and should only be carried out within the context of studies. Follow-up should correspond to active surveillance (AS), including MRI and fusion biopsy. Advantages and disadvantages of each ablation technique should be taken into consideration as well as the suitability of certain regions in the gland. Ideally, an individualized "à la carte" selection of various procedures should be offered. FT is well suited for patients with highly localized cancers at intermediate risk if standard therapies or AS is not possible or has been refused.
聚焦治疗（FT）应具有与全腺治疗相同的肿瘤学疗效，且副作用更少。采用PI-RADS v2标准多参数磁共振成像（MRI）以及融合或模板活检进行精确诊断是基本前提。现已开发出多种消融技术和治疗策略，包括半消融。治疗成功的定义仍不一致。唯一一项大型随机研究将其中一种治疗方法与标准治疗进行了比较。因此，即使在2019年，FT仍必须被视为实验性治疗，且仅应在研究背景下开展。随访应与主动监测（AS）一致，包括MRI和融合活检。应考虑每种消融技术的优缺点以及腺体中某些区域的适用性。理想情况下，应提供针对各种治疗方法的个性化“点菜式”选择。如果无法进行标准治疗或主动监测，或者患者拒绝接受，FT非常适合患有中度风险高度局限性癌症的患者。
