Nahar Bruno, Ajami Tarek, Williams Adam, Soodana Prakash Nachiketh, Khandekar Archan, Freitas Pedro F S, Malpani Ankur, Rayan Jonathan, Sureshkumar Keerthana, Ritch Chad R, Gonzalgo Mark L, Punnen Sanoj, Parekh Dipen J
Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA; Department of Urology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
Eur Urol Focus. 2024 Nov 29. doi: 10.1016/j.euf.2024.11.005.
Focal therapy is increasingly being used as a treatment for localized prostate cancer (PC). Our aim was to evaluate oncological outcomes, recurrence patterns, and survival after high-intensity focused ultrasound (HIFU), to discuss the lessons learned from our experience, and to propose strategies to enhance patient selection for HIFU treatment.
Between 2016 and 2023, 113 patients underwent focal HIFU treatment for PC. Follow-up included prostate-specific antigen (PSA) measurement every 3 mo, magnetic resonance imaging, and a control biopsy performed at 6 or 12 mo. Recurrence was categorized on the basis of location (infield or out-of-field) and Gleason grade group (clinically significant [CS] vs non-CS) with stratification by National Comprehensive Cancer Network risk groups. Kaplan-Meier curves were used to analyze survival outcomes, recurrence rates, and the need for retreatment.
Median follow-up was 29 mo and 92 patients (81%) had PSA follow-up for at least 12 mo. Local recurrence was observed in 34 patients (37%), which was CS in 16 (17%). The CS recurrence-free survival rate at 3 yr was worse for subgroups with high-risk or unfavorable intermediate-risk disease in comparison to the group with favorable intermediate-risk PC (40% and 53% vs 85%; log-rank p < 0.01), with a higher rate of out-of-field recurrence in the high-risk group. The Kaplan-Meier retreatment-free survival rate estimate was 71% at 3 yr. Sixteen patients (17%) underwent salvage local treatment. Study limitations include the small cohort size and relatively short follow-up.
HIFU is a promising alternative for localized PC in well-selected patients. However, patients with high-risk or unfavorable intermediate-risk PC are more likely to experience treatment failure.
We examined cancer control outcomes after high-intensity focused ultrasound for localized prostate cancer. We found that the rate of cancer recurrence was higher for patients with higher-risk disease. However, this treatment is a feasible and acceptable option for patients with intermediate risk.
聚焦治疗正越来越多地被用作局限性前列腺癌（PC）的一种治疗方法。我们的目的是评估高强度聚焦超声（HIFU）治疗后的肿瘤学结局、复发模式和生存率，讨论从我们的经验中吸取的教训，并提出提高HIFU治疗患者选择的策略。
2016年至2023年期间，113例患者接受了PC的聚焦HIFU治疗。随访包括每3个月测量前列腺特异性抗原（PSA）、磁共振成像以及在6或12个月时进行的对照活检。根据复发部位（场内或场外）和Gleason分级组（具有临床意义[CS]与无临床意义）进行分类，并按美国国立综合癌症网络风险组进行分层。采用Kaplan-Meier曲线分析生存结局、复发率和再次治疗的必要性。
中位随访时间为29个月，92例患者（81%）进行了至少12个月的PSA随访。34例患者（37%）观察到局部复发，其中16例（17%）为具有临床意义的复发。与低危或中危PC组相比，高危或不良中危疾病亚组3年时的无临床意义复发生存率更差（分别为40%和53%，而低危中危PC组为85%；对数秩检验p<0.01），高危组的场外复发率更高。3年时Kaplan-Meier无再次治疗生存率估计为71%。16例患者（17%）接受了挽救性局部治疗。研究局限性包括队列规模小和随访时间相对较短。
对于精心挑选的患者，HIFU是局限性PC的一种有前景的替代治疗方法。然而，高危或不良中危PC患者更有可能经历治疗失败。
我们研究了高强度聚焦超声治疗局限性前列腺癌后的癌症控制结局。我们发现，高危疾病患者的癌症复发率更高。然而，对于中危患者，这种治疗是一种可行且可接受的选择。
