Department of Urology, NYU Grossman School of Medicine, New York, NY.
Department of Urology, NYU Grossman School of Medicine, New York, NY; Departments of Urology and Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY.
Urology. 2021 Sep;155:124-129. doi: 10.1016/j.urology.2021.03.054. Epub 2021 Jun 4.
To characterize the oncologic outcomes 5 years following focal laser ablation (FLA) of localized prostate cancer.
36 men underwent in-bore FLA of prostate cancer at our institution between 2013 and 2015. Follow up included digital rectal examination and PSA testing, multiparametric MRI, and MR-guided biopsies. The primary outcome of interest was failure-free survival (FFS), defined as avoidance of salvage whole gland treatment, systemic therapy, metastasis, or death from prostate cancer.
Of the 36 men enrolled, 6 were ultimately lost to follow-up. Of the remaining 30, 25 (83%) have remained free from failure over a median follow-up of 71 months'. Among these patients, 10 (40%) developed in-field recurrence, with 9 undergoing salvage partial gland ablation with FLA, cryotherapy, or high-intensity focused ultrasound. Five patients underwent salvage whole gland or systemic treatment and were thus considered to have failed treatment. Two patients developed metastatic disease, and after receiving radiation and ADT, both currently have undetectable PSA levels. No patients in the cohort died from prostate cancer. Limitations include a small study cohort and lack of standardized surveillance protocols 2 years after treatment.
FLA for select cases of prostate cancer provides high rates of FFS, defined as freedom from whole gland or systemic treatment, metastasis, or death from prostate cancer. However, in- or out-of-field recurrence is common and often necessitates salvage ablation.
描述局部前列腺癌经聚焦激光消融（FLA）治疗 5 年后的肿瘤学结果。
2013 年至 2015 年间，我院 36 例男性患者接受了腔内 FLA 治疗前列腺癌。随访包括直肠指检和 PSA 检测、多参数 MRI 和 MR 引导活检。主要观察终点为无失败生存（FFS），定义为避免挽救性全腺治疗、全身治疗、转移或前列腺癌死亡。
36 例入组患者中，最终有 6 例失访。在其余 30 例患者中，中位随访 71 个月后，25 例（83%）无复发。在这些患者中，10 例（40%）发生了局部复发，其中 9 例接受了 FLA、冷冻治疗或高强度聚焦超声的挽救性部分腺消融治疗。5 例患者接受了挽救性全腺或全身治疗，因此被认为治疗失败。2 例患者发生了转移性疾病，在接受放疗和 ADT 后，目前 PSA 水平均无法检测到。该队列中无患者死于前列腺癌。局限性包括研究队列小且治疗后 2 年缺乏标准化监测方案。
对于某些前列腺癌病例，FLA 可提供较高的 FFS 率，定义为免于全腺或全身治疗、转移或前列腺癌死亡。然而，局部或远处复发很常见，常常需要挽救性消融治疗。
