Department of Pathology, Indiana University, Indianapolis, IN, 46202, USA.
Department of Pathology, Indiana University, Indianapolis, IN, 46202, USA.
Hum Pathol. 2022 Jan;119:79-84. doi: 10.1016/j.humpath.2021.11.005. Epub 2021 Nov 18.
High-intensity focused ultrasound (HIFU) is a noninvasive treatment option used for localized prostate cancer or salvage surgery after failed radiation therapy. Histological changes in post-treatment needle biopsies are reviewed to better understand HIFU failures. Between 2016 and 2021, 50 patients with localized prostate cancer were enrolled and treated in this study. Of these, 10 patients underwent salvage therapy after radiation failure and 7 did not have post-treatment needle biopsies available for review and were excluded. Inclusion criteria included pathologically confirmed prostate cancer and clinical stage T1/T2 disease. We describe the histological changes in post-treatment needle biopsies as part of routine follow-up. Biopsies were examined for presence, distribution and extent of residual adenocarcinoma, Gleason score, and ablative tissue changes. A total of 33 patients underwent HIFU hemi-ablation treatment of localized prostate cancer as primary treatment with post-treatment biopsies available for review. The average mean age of the patients was 64 years (range, 52-81 years). The average PSA (prostate-specific antigen) level of the patients was 6.3 ng/mL (range, 2.4-14.7 ng/mL). The Gleason scores assigned in pretreatment prostate needle biopsies are as follows: 3 + 3 (1 case, 3%), 3 + 4 (21 cases, 64%), 4 + 3 (9 cases, 27%), and 4 + 4 (2 cases, 6%). In post-treatment needle biopsies, 33 cases (100%) showed variable degrees of fibrosis ranging from mild to moderate. Twenty-four of 33 cases (73%) showed necrosis usually associated with acute and/or chronic inflammation. Histological examination of benign glands revealed glandular heterogeneity including atrophy and basal cell hyperplasia. Eight cases (24%) had residual prostatic adenocarcinoma after treatment, of which 4 cases were assigned Gleason score: ≥3 + 4. In cases with residual adenocarcinoma, 8 cases (100%) showed nuclear enlargement, 5 cases (63%), cytoplasmic vacuolization, and 1 case (13%) showed nuclear pyknosis; otherwise, no discernible effects of treatment were seen. Morphological alterations included a spectrum of changes ranging from extensive coagulative stromal necrosis secondary to thermal injury to atrophic changes in benign prostatic tissue after HIFU treatment. Our findings also support the hypothesis that HIFU failure results from inadequate targeting rather than failure within a treated zone.
高强度聚焦超声（HIFU）是一种非侵入性治疗选择，用于局部前列腺癌或放射治疗失败后的挽救性手术。回顾治疗后针活检的组织学变化，以更好地了解 HIFU 治疗失败的原因。在 2016 年至 2021 年间，本研究纳入了 50 名局部前列腺癌患者进行治疗。其中，10 名患者在放射治疗失败后接受了挽救性治疗，另外 7 名患者没有治疗后针活检结果可供回顾，因此被排除在外。纳入标准包括病理证实的前列腺癌和临床分期为 T1/T2 期疾病。我们描述了治疗后针活检中的组织学变化，这是常规随访的一部分。活检检查了残留腺癌的存在、分布和程度、Gleason 评分和消融组织变化。共有 33 名患者接受了局部前列腺癌的 HIFU 半消融治疗，作为主要治疗方法，并进行了治疗后活检以供回顾。患者的平均年龄为 64 岁（范围为 52-81 岁）。患者的平均 PSA（前列腺特异性抗原）水平为 6.3ng/mL（范围为 2.4-14.7ng/mL）。预处理前列腺针活检中的 Gleason 评分如下：3+3（1 例，3%）、3+4（21 例，64%）、4+3（9 例，27%）和 4+4（2 例，6%）。在治疗后针活检中，33 例（100%）显示不同程度的纤维化，从轻度到中度不等。24 例（73%）显示坏死，通常与急性和/或慢性炎症有关。良性腺体的组织学检查显示腺体异质性，包括萎缩和基底细胞增生。8 例（24%）在治疗后仍有前列腺腺癌残留，其中 4 例的 Gleason 评分为≥3+4。在有残留腺癌的病例中，8 例（100%）显示核增大，5 例（63%）显示细胞质空泡化，1 例（13%）显示核固缩；否则，没有观察到治疗的明显效果。形态学改变包括从广泛的凝固性间质坏死到良性前列腺组织的热损伤后萎缩改变的一系列变化。我们的发现也支持 HIFU 治疗失败是由于靶向不足而不是治疗区域内失败的假设。
