The Role of Focal Therapy in the Management of Localised Prostate Cancer: A Systematic Review

被引:242
作者
Valerio, Massimo [1 ,2 ,3 ]
Ahmed, Hashim U. [1 ,2 ]
Emberton, Mark [1 ,2 ]
Lawrentschuk, Nathan [4 ,5 ]
Lazzeri, Massimo [6 ]
Montironi, Rodolfo [7 ]
Nguyen, Paul L. [8 ]
Trachtenberg, John [9 ,10 ]
Polascik, Thomas J. [11 ,12 ]
机构
[1] UCL, Div Surg & Intervent Sci, London W1P 7NN, England
[2] Univ Coll Hosp NHS Fdn Trust, Dept Urol, London, England
[3] Univ Vaudois, Ctr Hosp, Dept Urol, Lausanne, Switzerland
[4] Univ Melbourne, Dept Surg, Melbourne, Vic, Australia
[5] Austin Hosp, Ludwig Inst Canc Res, Melbourne, Vic 3084, Australia
[6] Ist Sci San Raffaele, Osped San Raffaele Turro, Dept Urol, I-20132 Milan, Italy
[7] Polytech Univ Marche Reg, Sch Med, United Hosp, Sect Pathol Anat, Ancona, Italy
[8] Harvard Univ, Sch Med, Dana Farber Brigham & Womens Canc Ctr, Dept Radiat Oncol, Boston, MA USA
[9] Univ Hlth Network, Dept Surg Oncol, Div Urol, Toronto, ON, Canada
[10] Univ Toronto, Dept Surg, Toronto, ON, Canada
[11] Duke Univ, Med Ctr, Dept Surg, Div Urol, Durham, NC 27710 USA
[12] Duke Univ, Med Ctr, Duke Canc Inst, Durham, NC USA
基金
英国医学研究理事会; 英国惠康基金; 美国国家卫生研究院;
关键词
Brachytherapy; Cryotherapy; High-intensity focused; ultrasound; Laser therapy; Photodynamic therapy; Prostate cancer; INTENSITY-FOCUSED ULTRASOUND; RADICAL PROSTATECTOMY; TUMOR VOLUME; PATHOLOGICAL CHARACTERISTICS; CLINICAL-SIGNIFICANCE; TRANSPERINEAL BIOPSY; ACTIVE SURVEILLANCE; PATIENT SELECTION; GUIDED BIOPSY; INDEX LESION;
D O I
10.1016/j.eururo.2013.05.048
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: The incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy. Objective: To systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy. Evidence acquisition: Medline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included. Evidence synthesis: A total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatmentnai "ve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2-100%, 29-40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting. Conclusions: Our systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short-to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.
引用
收藏
页码:732 / 751
页数:20
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