Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.
J Urol. 2021 Sep;206(3):638-645. doi: 10.1097/JU.0000000000001787. Epub 2021 Apr 23.
We assessed whether prostate cancer (PCa) location might affect oncologic outcomes after focal therapy (FT) for PCa.
We identified 274 men receiving FT for PCa using either high intensity focused ultrasound (HIFU) or cryotherapy at a high volume center between 2009 and 2018. Survival analyses using Kaplan-Meier method were used to assess any additional treatment and radical treatment rates according to PCa location. Propensity-score match analysis was used to compare oncologic outcomes of HIFU vs cryotherapy according to PCa location. Covariates were prostate specific antigen, clinical stage, prostate volume, Gleason score, maximum cancer core length, percentage of positive cores and treatment modality.
A total of 166 and 108 men received FT with HIFU and cryotherapy, respectively. Overall, 39% (106) and 31% (85) received at least an additional treatment and a radical treatment after FT, respectively, with a median followup of 51 months. At 36 months' followup, the rates of any additional treatment-free survival were 71%, 75%, and 69% for patients with basal, mid-prostate and apical disease, respectively (p=0.7). At multivariable logistic regression analysis, PCa location was not significantly associated with higher risk of either any additional treatment or radical treatment (all p >0.4). After matching, there was no difference between HIFU vs cryotherapy in terms of any additional treatment rates according to PCa location.
The PCa location does not significantly affect the rate of failure after FT. The presence of an apical lesion should not be considered an exclusion criteria for FT. Both HIFU and cryotherapy likely achieve similar medium-term oncologic results regardless of PCa location.
我们评估前列腺癌（PCa）的位置是否会影响 PCa 局灶治疗（FT）后的肿瘤学结果。
我们在 2009 年至 2018 年间，在一家高容量中心，确定了 274 名接受高强度聚焦超声（HIFU）或冷冻治疗的 PCa 局灶治疗的男性患者。使用 Kaplan-Meier 方法进行生存分析，以评估根据 PCa 位置的任何额外治疗和根治性治疗的比率。使用倾向评分匹配分析，根据 PCa 位置比较 HIFU 与冷冻治疗的肿瘤学结果。协变量为前列腺特异性抗原、临床分期、前列腺体积、Gleason 评分、最大癌核长度、阳性核百分比和治疗方式。
共有 166 名和 108 名男性分别接受了 HIFU 和冷冻治疗的 FT。总的来说，分别有 39%（106 名）和 31%（85 名）的患者在 FT 后接受了至少一次额外治疗和根治性治疗，中位随访时间为 51 个月。在 36 个月的随访中，基底、中叶和尖部疾病患者的任何额外治疗无复发生存率分别为 71%、75%和 69%（p=0.7）。多变量逻辑回归分析显示，PCa 位置与任何额外治疗或根治性治疗的风险增加均无显著相关性（均 p＞0.4）。匹配后，根据 PCa 位置，HIFU 与冷冻治疗的任何额外治疗率无差异。
PCa 位置不会显著影响 FT 后的失败率。存在尖部病变不应作为 FT 的排除标准。无论 PCa 位置如何，HIFU 和冷冻治疗可能都能获得相似的中期肿瘤学结果。
