Department of Urology, Araba University Hospital. OSI Araba, Osakidetza, Vitoria-Gasteiz, Spain.
Department of Urology, Araba University Hospital. OSI Araba, Osakidetza, Vitoria-Gasteiz, Spain.
Clin Genitourin Cancer. 2023 Dec;21(6):712.e1-712.e8. doi: 10.1016/j.clgc.2023.04.013. Epub 2023 May 3.
Radical treatments and active surveillance are valid therapeutic approaches for low-risk prostate cancer. The oncologic effectiveness and morbidity of Radical Prostatectomy (RP) and radiotherapy have been broadly validated. Focal therapies pursue to reduce the morbidity observed after radical treatments, while preserving the oncologic effectiveness. This study aims to review the state-of-the-art about principles, oncologic effectiveness, morbidity, and side-effects associated with leading focal therapies. We review and summarize articles related with Cryotherapy, High-Intensity Focal Ultrasound (HIFU), Photodynamic Therapy (PDT), and Irreversible Electroporating (IRE) published in MEDLINE from 2000 to 2022. There is a wide heterogeneity in terms of the measurement of effectiveness and morbidity. Hence, comparing different energies, strategies and protocols seem to be unprecise and controversial. Cryosurgery and HIFU have reported more clinical experience than PDT and IRE. Biochemical recurrence rate after the first session varied from 4.5% to 23%, and up to 20% of patients underwent a salvage radical treatment. The reported incidence of erectile disfunction and urinary incontinence ranges from 3% to 50% and 0% to 34%, respectively. None randomized clinical trial comparing any focal therapy to any radical treatment has been published. We conclude that the expansion of focal therapies requires the consolidation of MRI-guided fusion biopsies in everyday clinical practice. Short-term oncologic effectiveness has been proved and supports their usefulness in low-risk patients unfit for surgical treatment. However, long-term effects and the clinical experience in intermediate and high-risk patients remains limited. Currently none of the focal therapies can be considered the Gold Standard for low-risk patients.
根治性治疗和主动监测是低危前列腺癌的有效治疗方法。根治性前列腺切除术（RP）和放疗的肿瘤学疗效和发病率已得到广泛验证。局部治疗旨在减少根治性治疗后观察到的发病率，同时保持肿瘤学疗效。本研究旨在回顾关于冷冻治疗、高强度聚焦超声（HIFU）、光动力疗法（PDT）和不可逆电穿孔（IRE）等主要局部治疗的最新进展，包括其原则、肿瘤学疗效、发病率和副作用。我们回顾并总结了 2000 年至 2022 年 MEDLINE 上发表的与冷冻治疗、高强度聚焦超声（HIFU）、光动力疗法（PDT）和不可逆电穿孔（IRE）相关的文章。在有效性和发病率的衡量方面存在很大的异质性。因此，比较不同的能量、策略和方案似乎不太准确，也存在争议。冷冻治疗和 HIFU 的临床经验比 PDT 和 IRE 更为丰富。首次治疗后生化复发率为 4.5%至 23%，多达 20%的患者接受了挽救性根治性治疗。报道的勃起功能障碍和尿失禁发生率分别为 3%至 50%和 0%至 34%。目前尚未发表任何比较任何局部治疗与任何根治性治疗的随机临床试验。我们得出结论，局部治疗的扩展需要在日常临床实践中巩固 MRI 引导下的融合活检。短期肿瘤学疗效已得到证实，并支持其在不适合手术治疗的低危患者中的应用。然而，中高危患者的长期效果和临床经验仍然有限。目前，还没有一种局部治疗方法可以被认为是低危患者的金标准。
