Marra Giancarlo, Marquis Alessandro, Suberville Michel, Woo Henry, Govorov Alexander, Hernandez-Porras Andres, Bhatti Kamran, Turkbey Baris, Katz Aaron E, Polascik Thomas J
Division of Urology, Department of Surgical Sciences, City of Health and Science, Molinette Hospital and University of Turin, Turin, Italy.
Smith Institute for Urology, Zucker School of Medicine at Hofstra/Northwell University, New York, NY, USA.
Prostate Cancer Prostatic Dis. 2024 Oct 4. doi: 10.1038/s41391-024-00905-0.
to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa).
a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications.
Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month "for-protocol" prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month.
FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.
迄今为止，对于接受聚焦治疗（FT）的患者，尚无标准化的、基于证据的随访方案，专家中心主要依赖自身经验和/或机构方案。我们旨在对前列腺癌（PCa）聚焦治疗后最有利的随访策略及其基本原理进行全面综述。
对文献进行叙述性综述，以研究PCa聚焦治疗的不同随访方案。关注的结果是消融后的肿瘤学和功能结果以及并发症。
FT后的肿瘤学成功通常定义为活检证实治疗区域无临床显著PCa。未治疗区域的新发PCa通常反映患者选择不准确，应作为原发性PCa进行治疗。在随访期间，应通过定期前列腺特异性抗原（PSA）、多参数磁共振成像（MRI）和前列腺活检来评估肿瘤学结果。PSA衍生物和新生物标志物的使用仍存在争议，因此不推荐使用。FT后的首次MRI应在6至12个月之间进行，以避免消融相关伪影，并在FT失败时避免诊断延迟。其他成像方式，如前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）扫描，前景广阔，但仍需在FT后环境中进行验证。12个月的“按方案”前列腺活检，包括靶向活检和系统活检，通常被认为是排除肿瘤持续/复发的首选活检方法。随后的多参数MRI和活检应根据临床情况采用风险适应性方法。功能结果应在第一年内使用经过验证的问卷定期评估，此时通常会恢复到新的基线水平。并发症尽管不常见，但应主要在第一个月进行严格监测。
FT随访是一个多方面的过程，涉及临床、放射学和组织学评估。需要开展评估不同随访策略和理想时机影响的研究，以制定FT后的标准化方案。
