Ghai Sangeet, Ni Tiffany T, Pavlovich Christian P, Futterer Jurgen J, Schade George R, Sanchez-Salas Rafael, Cornud Francois, Eggener Scott, Feller John F, George Arvin K, Villers Arnauld, de la Rosette Jean
Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Prostate Cancer Prostatic Dis. 2025 Mar 27. doi: 10.1038/s41391-025-00956-x.
Prostate cancer (PCa) management poses challenges due to treatment-related morbidities associated with conventional therapies. Focal therapy (FT) is emerging as a promising alternative for intermediate-risk PCa, aiming to selectively target localized cancerous lesions while preserving healthy tissue. This review explores emerging FT modalities for PCa treatment, focusing on transrectal MRI-guided focused ultrasound surgery (MRgFUS), transurethral ultrasound ablation (TULSA), focal laser ablation (FLA), and histotripsy.
A comprehensive literature search was conducted to identify studies and clinical trials related to FT. Relevant articles were selected and data were synthesized to provide insights into the efficacy and feasibility of MRgFUS, TULSA, FLA, and histotripsy for FT.
MRgFUS utilizes transrectal high-intensity focused ultrasound under MRI guidance to selectively ablate cancerous tissue, demonstrating positive outcomes in oncologic control and preservation of urinary and sexual function. TULSA employs transurethral delivery of high-intensity ultrasound energy under MRI guidance, showing promising results for whole gland treatment. FLA benefits from precise ablation, indicating effectiveness in tumor destruction while preserving quality-of-life. Histotripsy, a mechanical ablation method, exhibits promise by inducing tissue fractionation through bubble activity, offering advantages such as tissue selectivity and real-time treatment monitoring.
Emerging FT modalities present promising alternatives for the management of localized PCa, offering personalized treatment. Further research and clinical trials are warranted to establish the long-term efficacy of these techniques in PCa management.
由于传统疗法存在与治疗相关的发病率问题，前列腺癌（PCa）的管理面临挑战。聚焦治疗（FT）正在成为治疗中危PCa的一种有前景的替代方法，旨在选择性地靶向局部癌性病变，同时保留健康组织。本综述探讨了用于PCa治疗的新兴FT模式，重点关注经直肠MRI引导的聚焦超声手术（MRgFUS）、经尿道超声消融（TULSA）、聚焦激光消融（FLA）和组织超声破碎术。
进行了全面的文献检索，以识别与FT相关的研究和临床试验。选择相关文章并综合数据，以深入了解MRgFUS、TULSA、FLA和组织超声破碎术用于FT的疗效和可行性。
MRgFUS在MRI引导下利用经直肠高强度聚焦超声选择性地消融癌组织，在肿瘤控制以及保留泌尿和性功能方面显示出积极结果。TULSA在MRI引导下经尿道输送高强度超声能量，在全腺治疗方面显示出有前景的结果。FLA得益于精确消融，表明在破坏肿瘤的同时能保留生活质量。组织超声破碎术是一种机械消融方法，通过气泡活动诱导组织破碎，显示出前景，具有组织选择性和实时治疗监测等优点。
新兴的FT模式为局部PCa的管理提供了有前景的替代方法，可提供个性化治疗。有必要进行进一步的研究和临床试验，以确定这些技术在PCa管理中的长期疗效。
