Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.
Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK.
Prostate Cancer Prostatic Dis. 2020 Jun;23(2):232-243. doi: 10.1038/s41391-020-0206-6. Epub 2020 Feb 12.
Prostate cancer focal therapy aims to minimize the side-effects of whole gland treatments, such as radical prostatectomy and radiotherapy without compromising oncological efficacy. However, concerns exist regarding the multifocal nature of prostate cancer and the lack of long-term oncological data for this form of treatment. In recent years, the routine adoption of multi-parametric magnetic resonance imaging (mpMRI) of the prostate has improved our ability to select candidates for focal therapy and to accurately deliver this form of prostate cancer treatment.
We performed a review of the literature to provide a summary of the oncological and functional outcomes of men receiving primary prostate focal therapy. Furthermore, we discuss the impact of the routine implementation of mpMRI as part of the initial prostate cancer diagnostic pathway on the selection of candidates and delivery of focal therapy. Finally, we summarize knowledge gaps in the field and highlight active clinical trials in this arena.
Primary focal therapy involves the application of one of a number of energies that ablate tissue, such as cryotherapy and high intensity focused ultrasound (HIFU). Success is principally dependent on highly accurate patient selection and disease localization underpinned in large part by the routine integration of pre-biopsy mpMRI. Prospective medium-term follow-up data for primary HIFU and cryotherapy for men with intermediate-risk disease have shown acceptable cancer control with low risk of side effects and complications. Additional research is needed to clearly define an appropriate follow-up approach and to guide the management of in- and out-of-field recurrences. Multiple comparative trials with randomization against standard care are currently underway in men with intermediate- and high-risk prostate cancer.
The widespread adoption of prostate mpMRI has led to improved disease localization, enabling the performance of focal therapy as a viable treatment strategy for men with low volume intermediate-risk prostate cancer.
前列腺癌的局部治疗旨在最大限度地减少全腺体治疗（如根治性前列腺切除术和放疗）的副作用，同时不影响肿瘤疗效。然而，人们对前列腺癌的多灶性以及这种治疗形式缺乏长期肿瘤学数据存在担忧。近年来，前列腺多参数磁共振成像（mpMRI）的常规应用提高了我们选择局部治疗候选者的能力，并能准确实施这种前列腺癌治疗。
我们对文献进行了回顾，总结了接受原发性前列腺局部治疗的男性的肿瘤学和功能结果。此外，我们还讨论了 mpMRI 作为前列腺癌初始诊断途径的一部分的常规应用对候选者的选择和局部治疗的实施的影响。最后，我们总结了该领域的知识空白，并强调了该领域的活跃临床试验。
原发性局部治疗包括应用多种消融组织的能量，如冷冻疗法和高强度聚焦超声（HIFU）。成功主要取决于高度准确的患者选择和疾病定位，这在很大程度上依赖于术前 mpMRI 的常规整合。对于中危疾病患者的原发性 HIFU 和冷冻疗法的前瞻性中期随访数据显示，具有可接受的肿瘤控制效果，副作用和并发症风险低。需要进一步研究来明确适当的随访方法，并指导场内外复发的管理。目前正在中危和高危前列腺癌患者中进行多项与标准治疗相比的随机对照试验。
前列腺 mpMRI 的广泛应用导致了疾病定位的改善，使局部治疗成为低体积中危前列腺癌患者的一种可行治疗策略。
