Labbate Craig V, Klotz Laurence, Morrow Monica, Cooperberg Matthew, Esserman Laura, Eggener Scott E
Section of Urology, University of Chicago Medicine, Chicago, Illinois.
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2023 Jan;209(1):49-57. doi: 10.1097/JU.0000000000002972. Epub 2022 Sep 21.
Our goal was to review the history of the adoption of focal therapy for breast and prostate cancer and review common barriers to implementation.
A narrative review of the literature was performed of English-language MEDLINE indexed articles of breast-conservation therapy and prostate cancer focal therapy.
The introduction of focal therapy in breast cancer began with pioneering case series, and multiple randomized trials were performed prior to widespread adoption. Focal therapy for prostate cancer has just started the process of clinical trials with a single published randomized controlled trial. Commonly cited barriers to the adoption of prostate focal therapy include historical views of Halstedian tumor biology, tumor multifocality, over-detection, limitations in prostate imaging, and trial design end points.
The adoption of breast-conserving therapy evolved over decades and used data from multiple large, randomized, clinical trials. Barriers to the adoption of prostate cancer local therapy are similar to those faced by breast cancer clinical trials. Completion of well-designed trials in prostate cancer focal therapy is essential for its evidence-based adoption.
我们的目标是回顾乳腺癌和前列腺癌聚焦治疗的应用历史，并审视实施过程中的常见障碍。
对MEDLINE索引的关于保乳治疗和前列腺癌聚焦治疗的英文文章进行叙述性文献综述。
乳腺癌聚焦治疗始于开创性的病例系列研究，在广泛应用之前进行了多项随机试验。前列腺癌聚焦治疗刚刚开始临床试验进程，仅有一项已发表的随机对照试验。前列腺聚焦治疗应用过程中常见的障碍包括对霍尔斯特德肿瘤生物学的传统观点、肿瘤多灶性、过度检测、前列腺成像的局限性以及试验设计终点。
保乳治疗的应用历经数十年发展，并采用了多个大型随机临床试验的数据。前列腺癌局部治疗应用过程中面临的障碍与乳腺癌临床试验所面临的类似。设计良好的前列腺癌聚焦治疗试验的完成对于其基于证据的应用至关重要。
