Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH; Section of Urology, Department of Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, IL.
Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
Urol Oncol. 2024 May;42(5):158.e1-158.e10. doi: 10.1016/j.urolonc.2024.01.003. Epub 2024 Jan 19.
Focal therapy (FT) is a form of ablative treatment offered to men with localized, organ-confined prostate cancer (CaP). Pelvic multiparametric magnetic resonance imaging (mpMRI) and mpMRI/transrectal ultrasound fusion (MRI-US) guidance enable the precise delivery of FT with limited ablation of adjacent benign tissue or vital genitourinary structures. This article presents our findings on using MRI-US to perform FT as a primary treatment for men with intermediate-risk CaP.
Thirty-six men underwent MRI-US fusion-guided FT cryoablation at a single center from 2018 to 2023 as a primary treatment for intermediate-risk CaP. Following FT, quarterly prostate-specific antigen (PSA) testing and a 6 to 9 month mpMRI and combined MRI-US targeted and systematic biopsy were performed. Oncological outcomes were determined using several endpoints containing biochemical recurrence, imaging failure, and pathological failure. Functional outcomes were measured using reported erectile dysfunction/potency rates, urinary incontinence rates, and the American Urologic Association Symptom Score (AUA-SS) and Sexual Health Inventory for Men (SHIM) indices.
Median follow-up was 29.1 months, most (75%) of whom had grade group 2 CaP. Out of the 36 men, 32 (88.9%) completed the combined MRI-targeted and systematic biopsy follow-up after treatment. The study had no major complications, but 12 (33.3%) patients experienced Clavien-Dindo grade II or lower complications. For oncological outcomes, 6 (16.7%) men had biochemical recurrence, 9 (25%) showed imaging failure, and 8 (22.2%) met the criteria for positive biopsy- out-of-field vs. in-field. 88.2% of previously potent patients remained potent postoperatively at 12 months. All patients were continent at 12 months. There were no statistically significant changes in the AUA-SS and SHIM scores postoperatively.
MRI-US-guided cryoablation to target lesions in intermediate-risk CaP appears to be a safe treatment option, with functional outcomes indicating minimal short and intermediate-term morbidity and acceptable oncological outcomes. However, despite close monitoring and follow-up, there is still a limitation in accurately predicting/detecting pathological failure after FT. The long-term durability of FT for intermediate-risk, organ-confined CaP remains uncertain.
局部治疗（FT）是一种针对局限性、器官内前列腺癌（CaP）的消融治疗方法。盆腔多参数磁共振成像（mpMRI）和 mpMRI/经直肠超声融合（MRI-US）引导可实现 FT 的精确递送，同时限制对相邻良性组织或重要泌尿生殖结构的消融。本文介绍了我们在使用 MRI-US 对中危 CaP 患者进行 FT 作为主要治疗方法方面的发现。
2018 年至 2023 年，在一家中心，36 名男性接受了 MRI-US 融合引导的 FT 冷冻消融术，作为中危 CaP 的主要治疗方法。FT 后，每季度进行前列腺特异性抗原（PSA）检测，并进行 6 至 9 个月的 mpMRI 和联合 MRI-US 靶向和系统活检。使用包含生化复发、影像学失败和病理失败的多个终点来确定肿瘤学结果。使用报告的勃起功能障碍/勃起功能、尿失禁率以及美国泌尿外科学会症状评分（AUA-SS）和男性性功能健康调查（SHIM）指数来衡量功能结果。
中位随访时间为 29.1 个月，大多数（75%）患者患有 2 级 CaP。36 名男性中，32 名（88.9%）在治疗后完成了联合 MRI 靶向和系统活检随访。研究无重大并发症，但 12 名（33.3%）患者发生 Clavien-Dindo Ⅱ级或更低级别的并发症。在肿瘤学结果方面，6 名（16.7%）男性出现生化复发，9 名（25%）出现影像学失败，8 名（22.2%）符合活检阳性-靶外与靶内标准。12 个月时，88.2%的术前有勃起功能的患者仍保持勃起功能。所有患者在 12 个月时均无尿失禁。术后 AUA-SS 和 SHIM 评分无统计学意义变化。
MRI-US 引导的冷冻消融治疗中危 CaP 中的靶病变似乎是一种安全的治疗选择，功能结果表明短期和中期发病率低，肿瘤学结果可接受。然而，尽管进行了密切监测和随访，在准确预测/检测 FT 后的病理失败方面仍存在局限性。FT 治疗局限性、器官内中危 CaP 的长期耐久性仍不确定。
