Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement

被引：19

作者：

Deivasigamani, Sriram ^{[1
]}

Kotamarti, Srinath ^{[1
]}

Rastinehad, Ardeshir R. ^{[2
]}

Salas, Rafael Sanchez ^{[3
]}

de la Rosette, J. J. M. C. H. ^{[4
]}

Lepor, Herbert ^{[5
]}

Pinto, Peter ^{[6
]}

Ahmed, Hashim U. ^{[7
]}

Gill, Inderbir ^{[8
]}

Klotz, Laurence ^{[9
]}

Taneja, Samir S. ^{[5
]}

Emberton, Mark ^{[10
]}

Lawrentschuk, Nathan ^{[11
]}

Wysock, James ^{[5
]}

Feller, John F. ^{[12
]}

Crouzet, Sebastien ^{[13
]}

Kumar, M. Praveen ^{[14
]}

Seguier, Denis ^{[1
,15
]}

Adams, Eric S. ^{[1
]}

Michael, Zoe ^{[1
]}

Abreu, Andre ^{[8
]}

Tay, Kae Jack ^{[16
]}

Ward, John F. ^{[17
]}

Shinohara, Katsuto ^{[18
]}

Katz, Aaron E.

Villers, Arnauld

Chin, Joseph L. ^{[19
]}

Stricker, Phillip D. ^{[20
]}

Baco, Eduard ^{[21
]}

Macek, Petr ^{[22
]}

Ahmad, Ardalan E. ^{[23
]}

Chiu, Peter K. F. ^{[24
]}

Crawford, E. David ^{[25
]}

Rogers, Craig G. ^{[26
]}

Futterer, Jurgen J. ^{[27
]}

Rais-Bahrami, Soroush ^{[28
]}

Robertson, Cary N. ^{[1
]}

Hadaschik, Boris ^{[29
]}

Marra, Giancarlo ^{[30
]}

Valerio, Massimo ^{[31
]}

Tai, Kian ^{[32
]}

Kasivisvanathan, Veeru ^{[10
]}

Tan, Wei Phin ^{[5
]}

Lomas, Derek ^{[33
]}

Walz, Jochen ^{[34
]}

Guimaraes, Gustavo Cardoso ^{[35
]}

Mertziotis, Nikos I. ^{[36
]}

Becher, Ezequiel ^{[37
]}

Finelli, Antonio ^{[9
]}

Kasraeian, Ali ^{[38
]}

机构：

[1] Duke Canc Inst, Durham, NC USA

[2] Smith Inst Urol Lenox Hill, New York, NY USA

[3] McGill Univ, Div Urol, Montreal, PQ, Canada

[4] Istanbul Medipol Mega Univ Hosp, Dept Urol, Istanbul, Turkiye

[5] NYU, Dept Urol, NYU Langone Hlth, Sch Med, New York, NY USA

[6] NCI, Urol Oncol Branch, NIH, Bethesda, MD USA

[7] Imperial Coll London, Div Urol, London, England

[8] Univ Southern Calif, Keck Med USC, USC Inst Urol, Los Angeles, CA USA

[9] Univ Toronto, Div Urol, Toronto, ON, Canada

[10] UCL, Div Surg, London, England

[11] Royal Melbourne Hosp, Dept Urol, Melbourne, Vic, Australia

[12] Halo Diagnost, Indian Wells, CA USA

[13] Univ Hosp Lyon, Dept Urol, Lyon, France

[14] PGIMER, Dept Pharmacol, Chandigarh, India

[15] Univ Lille Nord France, Dept Urol, Lille, France

[16] Singapore Gen Hosp, Dept Urol, Singapore, Singapore

[17] MD Anderson Canc Ctr, Dept Urol, Houston, TX USA

[18] Univ Calif San Francisco, Dept Urol, San Francisco, CA USA

[19] Univ Western Ontario, Dept Urol, London, ON, Canada

[20] Univ New South Wales, Dept Urol, Sydney, Australia

[21] Oslo Univ Hosp, Dept Urol, Oslo, Norway

[22] Inst Mutualiste Montsouris, Dept Urol, Paris, France

[23] Univ Manitoba, Dept Urol, Winnipeg, MB, Canada

[24] Chinese Univ Hong Kong, SH Ho Urol Ctr, Dept Surg, Hong Kong, Peoples R China

[25] Univ Calif San Diego, Dept Urol, San Diego, CA USA

[26] Henry Ford Hlth, Vattikuti Urol Inst, Detroit, MI USA

[27] Radboud Univ Nijmegen, Nijmegen Med Ctr, Dept Radiol, Nijmegen, Netherlands

[28] Univ Alabama Birmingham, Dept Urol, Birmingham, AL USA

[29] Univ Hosp Essen, Dept Urol, Essen, Germany

[30] Univ Hosp Turin, Dept Urol, Turin, Italy

[31] Univ Hosp Lausanne, Serv Urol, Lausanne, Switzerland

[32] Farrer Pk Hosp, Surgi TEN Specialists, Singapore, Singapore

[33] Mayo Clin, Dept Urol, Rochester, MN USA

[34] Paoli Calmettes Inst, Dept Urol, Canc Ctr, Marseille, France

[35] BP A Beneficencia Portuguesa Silo Paulo, Silo Paulo, Brazil

[36] Metropolitan Gen Hosp, Dept Urol, Athens, Greece

[37] Ctr Urol CDU, Buenos Aires, DF, Argentina

[38] Kasraeian Urol, Jacksonville, FL USA

[39] Chesapeake Urol, Silver Spring, MD USA

[40] Sutter Hlth, Dept Urol, Sacramento, CA USA

[41] Istanbul Univ, Dept Radiol, Istanbul, Turkiye

[42] Ochsner Clin Fdn, Dept Urol, New Orleans, LA USA

[43] ASKLEPOIS Clin Barmbek, Dept Urol, Hamburg, Germany

[44] UT Southwestern Med Ctr, Dept Urol, Dallas, TX USA

[45] Amsterdam Med Ctr, Dept Urol, Amsterdam, Netherlands

[46] Swiss Int Prostate Centelenor, Dept Intervent Oncol, Geneva, Switzerland

[47] Cleveland Clin, Dept Urol, Cleveland, OH USA

[48] Hampshire Hosp NHS Fdn Trust, Urol, Basingstoke, England

[49] Urologist Specialist Grp, Urol Res Network, Miami Lakes, FL USA

[50] Washington Univ, Sch Med, Div Urol, St Louis, MO USA

来源：

EUROPEAN UROLOGY | 2023年 / 84卷 / 06期

关键词：

Ablation therapy; Best practice statement; Cryotherapy; High-intensity focused; ultrasound; Functional outcomes; Focal Therapy Society; Oncological outcomes; Prostate cancer; Whole-gland ablation; INTENSITY FOCUSED ULTRASOUND; RADICAL PROSTATECTOMY; RANDOMIZED-TRIAL; OUTCOMES; CRYOABLATION; RISK; BRACHYTHERAPY; RADIOTHERAPY; CRYOTHERAPY; CRYOSURGERY;

D O I：

10.1016/j.eururo.2023.06.013

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Context: Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up.Objective: To evaluate the real-world data on the mid-to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings.Evidence acquisition: We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed.Evidence synthesis: Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71-79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively.Conclusions: The mid-to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate-to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. Patient summary: Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate-to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences. Published by Elsevier B.V. on behalf of European Association of Urology.

引用

页码：547 / 560

页数：14

共 58 条

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