Kovács Attila, Pinkawa Michael
Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, MediClin Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Germany.
Klinik für Strahlentherapie, MediClin Robert Janker Klinik, Bonn, Germany.
Radiologe. 2019 Dec;59(Suppl 1):28-39. doi: 10.1007/s00117-019-00632-x.
Interventional therapies are emerging modalities for the treatment of localized prostate cancer. Their aim is to reduce the morbidity associated with radical therapies (rT) by minimizing damage to non-cancerous tissue, with priority given to sparing key structures such as the neurovascular bundles, external sphincter, bladder neck, and rectum, while maintaining local cancer control. Interventional ablative technologies deliver energy in different ways to destroy cancer cells. The most widely investigated techniques are brachytherapy, external beam radiotherapy, cryotherapy, and high-intensity focused ultrasound. Although functional outcomes of focal therapies have been encouraging, with generally low rates of urinary incontinence and erectile dysfunction, robust medium- and long-term oncological outcomes are not available for all techniques. To date, major controversies in focal therapy concern appropriate patient selection, efficacy of focal therapies, as well as treatment paradigms based on the dominant index lesion hypothesis. This review articles discusses the current status of interventional therapies and the oncological and functional outcomes.
介入治疗是治疗局限性前列腺癌的新兴方式。其目的是通过尽量减少对非癌组织的损伤来降低与根治性治疗（rT）相关的发病率，优先保护神经血管束、外括约肌、膀胱颈和直肠等关键结构，同时维持局部癌症控制。介入消融技术以不同方式传递能量来破坏癌细胞。研究最广泛的技术是近距离放射治疗、外照射放疗、冷冻治疗和高强度聚焦超声。尽管局部治疗的功能结果令人鼓舞，尿失禁和勃起功能障碍的发生率通常较低，但并非所有技术都有可靠的中长期肿瘤学结果。迄今为止，局部治疗的主要争议涉及合适的患者选择、局部治疗的疗效以及基于主要指数病灶假说的治疗模式。这篇综述文章讨论了介入治疗的现状以及肿瘤学和功能结果。
