Shoji Sunao, Koizumi Norihiro, Yuzuriha Soichiro, Kano Tatsuo, Ogawa Takahiro, Nakano Mayura, Kawakami Masayoshi, Nitta Masahiro, Hasegawa Masanori, Miyajima Akira
Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Department of Urology, Tokai University Hachioji Hospital, Tokyo, Japan.
J Med Ultrason (2001). 2022 Jan 15. doi: 10.1007/s10396-021-01183-2.
High-intensity focused ultrasound (HIFU) was experimentally used for focal therapy for anti-cancer effects in prostate cancer (PC). Focal therapy is a diagnosis-based investigational treatment option for localized PC that cures clinically significant PC (csPC) while preserving the anatomical structures related to urinary and sexual function based on its spread observed using multi-parametric magnetic resonance imaging (mpMRI). The European Association of Urology indicated that the current status of focal therapy for localized PC was an investigational modality and encouraged prospective recording of outcomes and recruitment of suitable patients in 2018. During the last few years, large-population multi- and single-center prospective studies have investigated focal therapy as a treatment strategy for localized PC. In a multicenter prospective study with 5-year follow-up, failure-free survival, which was defined as avoidance of local salvage therapy (surgery or radiotherapy), systemic therapy, metastases, and prostate cancer-specific death, was 88%. In the previous studies, there was no significant influence on urinary function before and at 3 months after the treatment, although transient impairment was reported 1 month after the treatment. Pad- and leak-free continence was preserved in 80-100% of the patients after treatment. Erectile function was significantly impaired in the initial 3 months after treatment compared to the pretreatment values, but it improved 6 months after the focal therapy in the previous reports. Paired comparison studies and cohort studies with long-term follow-up will contribute to verifying this treatment's clinical outcomes for patients with localized PC.
高强度聚焦超声（HIFU）已被用于前列腺癌（PC）抗癌效应的局部治疗实验。局部治疗是一种基于诊断的局限性PC研究性治疗选择，它基于多参数磁共振成像（mpMRI）观察到的肿瘤扩散情况，在保留与泌尿和性功能相关的解剖结构的同时，治愈具有临床意义的PC（csPC）。欧洲泌尿外科学会指出，局限性PC局部治疗的现状是一种研究性治疗方式，并在2018年鼓励对治疗结果进行前瞻性记录以及招募合适的患者。在过去几年中，大规模的多中心和单中心前瞻性研究已将局部治疗作为局限性PC的一种治疗策略进行了调查。在一项为期5年随访的多中心前瞻性研究中，无失败生存率（定义为避免局部挽救性治疗（手术或放疗）、全身治疗、转移和前列腺癌特异性死亡）为88%。在先前的研究中，尽管有报告称治疗后1个月出现短暂性损伤，但治疗前和治疗后3个月对泌尿功能没有显著影响。治疗后80%-100%的患者保持了无尿垫和无渗漏的控尿能力。与治疗前相比，治疗后的最初3个月勃起功能明显受损，但在先前的报告中，局部治疗后6个月勃起功能有所改善。配对比较研究和长期随访的队列研究将有助于验证这种治疗对局限性PC患者的临床疗效。
