Surveillance after Focal Therapy - a Comprehensive Review.

IF 5.1 2区 医学 Q1 ONCOLOGY
Giancarlo Marra, Alessandro Marquis, Michel Suberville, Henry Woo, Alexander Govorov, Andres Hernandez-Porras, Kamran Bhatti, Baris Turkbey, Aaron E Katz, Thomas J Polascik
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Abstract

Background: to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa).

Methods: a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications.

Results: Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month "for-protocol" prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month.

Conclusions: FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.

病灶治疗后的监控--全面回顾。
背景:迄今为止,对接受病灶治疗(FT)患者的监测尚无标准化、循证的随访计划,专家中心主要依靠自身的经验和/或机构协议。我们的目的是对前列腺癌(PCa)病灶治疗后最有利的随访策略及其合理性进行一次全面回顾。方法:对不同的前列腺癌前列腺电切术后随访方案进行了文献综述,关注的结果是消融术后的肿瘤学和功能性结果以及并发症:FT术后的肿瘤学成功一般定义为活检证实治疗区无临床意义的PCa。未治疗区域的新发 PCa 通常反映出患者选择不准确,应作为原发性 PCa 治疗。在随访期间,应定期通过 PSA、多参数磁共振成像和前列腺活检来评估肿瘤结果。PSA 衍生物和新生物标记物的使用仍存在争议,因此不建议使用。前列腺前列腺电切术后的首次磁共振成像应在 6-12 个月之间进行,以避免消融相关伪影和前列腺前列腺电切术失败时的诊断延迟。其他成像方式,如 PSMA PET/CT 扫描很有前景,但仍需在 FT 后进行验证。一般认为,为期12个月的 "按方案 "前列腺活检(包括靶向活检和系统活检)是排除肿瘤持续存在/复发的首选活检方法。随后的 mpMRI 和活检应根据临床情况采取风险适应性方法。应在第一年内定期使用有效的问卷对功能结果进行评估,因为在第一年内通常会恢复到一个新的基线。并发症尽管并不常见,但应主要在第一个月进行严格监测:FT随访是一个涉及临床、放射学和组织学评估的多方面过程。需要对不同随访策略和理想时间的影响进行评估研究,以制定标准化的 FT 随访方案。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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