Skribek Benjamin, Szabó Anett, Ács Júlia, Cavalcante Bianca Golzio Navarro, Sipos Boglárka Dorina, Hegyi Péter, Mátrai Péter, Nyirády Péter, Ács Nándor, Majoros Attila, Deák Pál Ákos
Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.
Cancers (Basel). 2025 Aug 30;17(17):2863. doi: 10.3390/cancers17172863.
Minimally invasive interventions, including irreversible electroporation (IRE), cryoablation, and high-intensity focused ultrasound (HIFU), offer promising alternatives for the treatment of low- and intermediate-risk prostate cancer. We aimed to evaluate the oncological efficacy and safety of these treatments.
A systematic search of MEDLINE, Central, and EMBASE was conducted up to 5 January 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Recurrence, complication, survival, biochemical, and retreatment rates were evaluated, with risk of bias assessed using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) and Risk of Bias 2 (RoB2) tools.
85 studies met the inclusion criteria, comprising 42 prospective cohort studies, 36 retrospective cohort studies, six registries, and one randomized controlled trial. Whole-gland HIFU showed significantly lower recurrence (15%) and postoperative mean PSA levels (0.68 ng/mL) than focal HIFU (24%, 2.81 ng/mL). Recurrence rates were similar for focal vs. extended IRE (30% vs. 26%) and focal vs. whole-gland cryoablation (18% vs. 13%). In-field and out-of-field recurrence rates were similar across treatment modalities (5-15%). Retreatment rates were low, with 6-7% of patients receiving a second ablation and 2-8% progressing to radical or hormonal therapy. Major complications were consistently rare. One-year biochemical recurrence-free survival (BRFS) exceeded 95%, and five-year BRFS approached 80% for HIFU and cryoablation.
Minimally invasive focal and whole-gland therapies are safe and effective for treating low- and intermediate-risk prostate cancer, with high survival and low major complication rates. Notably, whole-gland HIFU achieves superior biochemical control and lower recurrence than focal HIFU, emphasizing the clinical importance of treatment extent.
包括不可逆电穿孔（IRE）、冷冻消融和高强度聚焦超声（HIFU）在内的微创干预措施为低风险和中风险前列腺癌的治疗提供了有前景的替代方案。我们旨在评估这些治疗方法的肿瘤学疗效和安全性。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，截至2025年1月5日对MEDLINE、Central和EMBASE进行了系统检索。评估了复发率、并发症发生率、生存率、生化指标和再次治疗率，并使用干预性非随机研究的偏倚风险（ROBINS-I）和偏倚风险2（RoB2）工具评估偏倚风险。
85项研究符合纳入标准，包括42项前瞻性队列研究、36项回顾性队列研究、6项登记研究和1项随机对照试验。与局部HIFU（24%，2.81 ng/mL）相比，全腺HIFU的复发率（15%）和术后平均前列腺特异性抗原（PSA）水平（0.68 ng/mL）显著更低。局部IRE与扩展IRE的复发率相似（30%对26%），局部冷冻消融与全腺冷冻消融的复发率相似（18%对13%）。各治疗方式的场内和场外复发率相似（5%-15%）。再次治疗率较低，6%-7%的患者接受了第二次消融，2%-8%的患者进展为根治性或激素治疗。主要并发症一直很少见。HIFU和冷冻消融的1年无生化复发生存率（BRFS）超过95%，5年BRFS接近80%。
微创局部和全腺治疗对于低风险和中风险前列腺癌是安全有效的，生存率高且主要并发症发生率低。值得注意的是，与局部HIFU相比，全腺HIFU实现了更好的生化控制和更低的复发率，突出了治疗范围的临床重要性。
