Oncologic and Functional Outcomes of Partial Gland Ablation with High Intensity Focused Ultrasound for Localized Prostate Cancer
Oncologic and Functional Outcomes of Partial Gland Ablation with High Intensity Focused Ultrasound for Localized Prostate Cancer
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DOI：
10.1016/j.juro.2018.07.040
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发表时间：
2019-01-01
影响因子：
6.6
通讯作者：
Klotz, Laurence
中科院分区：
文献类型：
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作者：
Bass, Roman;Fleshner, Neil;Klotz, Laurence
目的：我们对高强度聚焦超声作为局限性前列腺癌主要治疗方法的疗效进行了一系列的回顾性研究。这是已发表的最大的中高风险患者系列之一。材料和方法：我们对2013年1月至2017年9月期间接受部分腺体切除的患者进行了多中心的回顾性分析。根据磁共振成像，活体检查证实为局部性疾病和多焦点受限的患者更喜欢微创门诊治疗，他们使用Sonablate(R)500系统进行治疗。分析肿瘤学和功能预后以及复发的危险因素。结果：150名患者共进行了166次手术。2级或2级以上的病例占89%。平均随访+/-SD 24.3+/-14.4个月。前列腺特异性抗原平均值从7.9+/-6.8 ng/ml下降到2.7+/-3.1 ng/ml的最低点，下降了65%。87例(52%)高危复发患者接受了确认性活检。临床显著癌(2级或以上)37例(42%)。阳性核数目较多、肿瘤位置居中或前列腺特异性抗原较高的患者复发的可能性较高。抢救治疗37例(24.6%)，其中重复部分腺体消融16例。结论：部分腺体消融联合高强度聚焦超声治疗是安全的，对功能预后的影响最小。42%的复发高危患者出现局部复发和/或失败。位于中间的肿瘤与较高的失败率相关。严重并发症很少见。81%的患者避免了全腺体治疗。
Purpose: We assessed the outcomes of high intensity focused ultrasound as primary treatment of localized prostate cancer in a retrospective series. This represents one of the largest published series of patients at intermediate and high risk.Matrials and Methods: We performed a retrospective multicenter analysis of patients who underwent partial gland ablation between January 2013 and September 2017. Patients with biopsy proven localized disease and limited multifocality based on magnetic resonance imaging who preferred minimally invasive outpatient therapy were treated with the Sonablate (R) 500 system. Oncologic and functional outcomes were analyzed as well as risk factors for recurrence.Results: A total of 166 procedures were performed in 150 patients. Grade Group 2 or greater was present in 89% of cases. Mean +/- SD followup was 24.3 +/- 14.4 months. Mean prostate specific antigen decreased 65% from 7.9 +/- 6.8 ng/ml to a nadir of 2.7 +/- 3.1 ng/ml. Confirmatory biopsies were performed in 87 patients (52%) at high risk for recurrence. Clinically significant cancer (Grade Group 2 or greater) was detected in 37 cases (42%). Patients with a higher number of positive cores, a medial tumor location or higher prostate specific antigen had a higher probability of recurrence. Salvage treatment was done in 37 patients (24.6%), including 16 repeat partial gland ablation procedures.Conclusions: Partial gland ablation with high intensity focused ultrasound therapy was safe and it had a minimal impact on functional outcomes. Local recurrence and/or failure occurred in 42% of patients at high risk for recurrence. Medially located tumors were associated with a higher failure rate. Serious complications were rare. Whole gland treatment was avoided in 81% of patients.