Determining Optimal Patient Selection for High-intensity Focused Ultrasound for Prostate Cancer.

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2025-08-02 DOI:10.1016/j.euf.2025.06.007

Kevin Shee, William A Pace, Andrew W Liu, Janet E Cowan, Vishvak Subramanyam, Cameron Agapito, Samuel L Washington, Matthew R Cooperberg, Peter R Carroll, Katsuto Shinohara, Hao G Nguyen

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引用次数: 0

Abstract

Background and objective: Magnetic resonance imaging (MRI)/ultrasound-guided high-intensity focused ultrasound (HIFU) ablates prostate cancer with promising cancer control and minimal impact on sexual or urinary function. However, recurrence remains a concern. This study identifies factors associated with recurrence and treatment failure to optimize patient selection.

Methods: Men who underwent robotic HIFU (FocalOne) at University of California San Francisco (2021-2023) and had a 1-yr post-HIFU MRI-fusion biopsy were included. The primary outcomes were biopsy-proven in-field and overall recurrence. The secondary outcomes included treatment failure (salvage whole-gland treatment with surgery or radiation, or development of metastases) and changes in urinary/sexual function. Cox proportional hazards and multivariable logistic regression were used for an analysis.

Key findings and limitations: Among 135 men with a follow-up biopsy at 12 mo, pre-HIFU Gleason grade ≥3 (≥GG3; hazard ratio [HR] 3.11; 95% confidence interval [CI] 1.30-7.47) and a high genomic risk score (HR 2.87; 95% CI 1.18-6.99) were associated with in-field biopsy-proven recurrence. Overall biopsy-proven recurrence was linked to ≥GG3 (HR 2.62; 95% CI 1.03-6.67) and prostate-specific antigen (PSA) >10 versus <6 ng/ml (HR 5.64; 95% CI 1.82-17.48). The rates of treatment failure requiring salvage whole-gland treatment or metastasis was 4% at 1 yr and 16% overall, with a median (interquartile range) time to treatment failure of 16 (13-18) mo. Urinary and sexual function remained unchanged; no Clavien-Dindo grade >2 complications, urethral stricture, or urethra-rectal fistula were recorded.

Conclusions and clinical implications: Pre-HIFU ≥GG3 disease, a high genomic risk score, and elevated PSA correlate with local recurrence. These findings emphasize the importance of careful patient selection, as HIFU can effectively control cancer with minimal urinary or sexual side effects in suitable patients.

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确定前列腺癌高强度聚焦超声的最佳患者选择。

背景与目的：磁共振成像(MRI)/超声引导下的高强度聚焦超声（HIFU）消融前列腺癌，有希望控制癌症，对性功能和泌尿功能的影响最小。然而，复发仍然是一个问题。本研究确定了与复发和治疗失败相关的因素，以优化患者选择。方法：纳入在加州大学旧金山分校（2021-2023）接受机器人HIFU （FocalOne）并在HIFU后进行1年mri融合活检的男性。主要结果是活检证实的现场和总体复发。次要结局包括治疗失败（手术或放疗挽救全腺体治疗，或转移的发展）和泌尿/性功能的改变。采用Cox比例风险和多变量logistic回归进行分析。主要发现和局限性：135名随访12个月活检的男性中，hifu前Gleason分级≥3(≥GG3；风险比[HR] 3.11；95%可信区间[CI] 1.30-7.47)和高基因组风险评分(HR 2.87；95% CI 1.18-6.99)与现场活检证实的复发相关。总体活检证实的复发与GG3≥相关(HR 2.62；95% CI 1.03-6.67)和前列腺特异性抗原（PSA） bbb10 vs 2并发症，尿道狭窄，或尿道直肠瘘记录。结论和临床意义：hifu前≥GG3疾病、高基因组风险评分和PSA升高与局部复发相关。这些发现强调了仔细选择患者的重要性，因为HIFU可以有效地控制癌症，并且对合适的患者的泌尿或性副作用最小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

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.