ALTA Klinik, Bielefeld, Germany.
Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, Munich, Germany; Department of Urology, University Hospital, LMU Munich, Munich, Germany.
Urol Oncol. 2021 Dec;39(12):830.e9-830.e16. doi: 10.1016/j.urolonc.2021.04.022. Epub 2021 Jun 16.
OBJECTIVES: MR-guided transurethral ultrasound ablation (TULSA) has primarily been investigated for whole-gland prostate ablation, even though the technology is also well-suited for partial gland treatment. The objectives were to perform a clinical service evaluation of partial to whole-gland TULSA for patients with localized prostate cancer (CaP). TULSA was also evaluated as a combined therapy for a subset of patients presenting with both cancer and concurrent benign prostate hyperplasia (BPH). SUBJECTS AND METHODS: This retrospective, consecutive clinical service evaluation included men with histopathologically-confirmed CaP who underwent TULSA either as primary or salvage treatment. The planned ablation was dependent on the individual tumor characteristics, concurrent BPH and patient preferences. The Clavien-Dindo classification was used to record complications. Surgeon-assessed functional outcomes were reported. Early treatment success was defined by negative multiparametric MRI (mpMRI) and lack of prostate specific antigen (PSA) recurrence. RESULTS: Fifty-two consecutive patients (47 treatment-naïve and 5 salvage) were included, with median follow-up of sixteen months and a max of thirty-six months. Baseline median (IQR) age and PSA were 67 years (63-76) and 8.0 ng/ml (5.2-13), respectively. Two Grade IIIa adverse events were observed, with no bowel-related complications. For urinary continence outcomes, 1 patient worsened to 1 pad per day. All patients who were previously potent maintained erectile potency. Of the patient subgroup also seeking treatment for BPH, 83% reported symptom improvement. Median (IQR) PSA nadir after primary treatment was 1.1 ng/ml (0.5-2.1). Early treatment success was 88%. Nine patients underwent a single repeat TULSA. CONCLUSION: Customized prostate ablation with TULSA offers flexible ablation according to patients' disease characteristics and treatment expectations, providing favorable safety and promising early MRI and PSA results. TULSA is a feasible combination therapy for patients with both cancer and concurrent BPH.
目的：磁共振引导经尿道超声消融（TULSA）主要用于全腺前列腺消融，尽管该技术也非常适合部分腺治疗。目的是对局部前列腺癌（CaP）患者进行 TULSA 的部分至全腺临床服务评估。TULSA 还被评估为一种联合治疗方法，用于同时患有癌症和良性前列腺增生（BPH）的患者。
方法：这是一项回顾性、连续的临床服务评估，包括经组织病理学证实患有 CaP 的男性，他们接受 TULSA 作为初次或挽救性治疗。计划的消融取决于个体肿瘤特征、并发 BPH 和患者偏好。使用 Clavien-Dindo 分类记录并发症。报告了外科医生评估的功能结果。早期治疗成功定义为阴性多参数磁共振成像（mpMRI）和前列腺特异性抗原（PSA）无复发。
结果：共纳入 52 例连续患者（47 例初次治疗，5 例挽救性治疗），中位随访时间为 16 个月，最长随访时间为 36 个月。基线中位数（IQR）年龄和 PSA 分别为 67 岁（63-76）和 8.0ng/ml（5.2-13）。观察到 2 例 IIIa 级不良事件，无肠道相关并发症。在尿控方面，1 例患者恶化至每天使用 1 片尿垫。所有之前有勃起功能的患者均保持勃起功能。在同时寻求 BPH 治疗的患者亚组中，83%报告症状改善。初次治疗后中位（IQR）PSA 最低值为 1.1ng/ml（0.5-2.1）。早期治疗成功率为 88%。9 例患者接受了单次重复 TULSA。
结论：TULSA 定制的前列腺消融根据患者的疾病特征和治疗预期提供灵活的消融，具有良好的安全性和有前景的早期 MRI 和 PSA 结果。TULSA 是一种可行的联合治疗方法，适用于同时患有癌症和并发 BPH 的患者。
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