局部高强度聚焦超声治疗局限性前列腺癌后的生存结果和复发模式:对患者选择的见解和经验教训。

IF 4.8 2区 医学 Q1 UROLOGY & NEPHROLOGY European urology focus Pub Date : 2024-11-29 DOI:10.1016/j.euf.2024.11.005
Bruno Nahar, Tarek Ajami, Adam Williams, Nachiketh Soodana Prakash, Archan Khandekar, Pedro F S Freitas, Ankur Malpani, Jonathan Rayan, Keerthana Sureshkumar, Chad R Ritch, Mark L Gonzalgo, Sanoj Punnen, Dipen J Parekh
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引用次数: 0

摘要

背景与目的:局灶性治疗越来越多地被用于治疗局限性前列腺癌(PC)。我们的目的是评估高强度聚焦超声(HIFU)后的肿瘤预后、复发模式和生存率,讨论从我们的经验中吸取的教训,并提出策略,以提高患者对HIFU治疗的选择。方法:2016年至2023年,113例PC患者行局灶HIFU治疗。随访包括每3个月进行一次前列腺特异性抗原(PSA)测量,磁共振成像,并在6或12个月进行对照活检。复发根据位置(野内或野外)和Gleason分级组(临床显著[CS] vs非CS)进行分类,并根据国家综合癌症网络风险组进行分层。Kaplan-Meier曲线用于分析生存结果、复发率和再治疗的需要。主要发现和局限性:中位随访时间为29个月,92例(81%)患者进行了至少12个月的PSA随访。34例(37%)患者出现局部复发,16例(17%)患者出现CS。高风险或不良中危疾病亚组的3年无CS复发生存率比良好中危PC组更差(40%和53% vs 85%;结论和临床意义:HIFU是一种很有希望的治疗局部PC的方法。然而,高危或不利的中危PC患者更容易出现治疗失败。患者总结:我们检查了高强度聚焦超声治疗局限性前列腺癌后的癌症控制结果。我们发现,高风险疾病患者的癌症复发率更高。然而,对于中度风险的患者,这种治疗是一种可行和可接受的选择。
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Survival Outcomes and Recurrence Patterns Following Focal High-intensity Focused Ultrasound Treatment for Localized Prostate Cancer: Insights on Patient Selection and Lessons Learned.

Background and objective: 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.

Methods: 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.

Key findings and limitations: 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.

Conclusions and clinical implications: 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.

Patient summary: 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.

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来源期刊
European urology focus
European urology focus Medicine-Urology
CiteScore
10.40
自引率
3.70%
发文量
274
审稿时长
23 days
期刊介绍: European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.
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