Multimodality focal therapy for prostate cancer: outcome of the à la carte approach in clinical practice

IF 4 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International Pub Date : 2025-12-01 Epub Date: 2025-03-24 DOI:10.1016/j.prnil.2025.03.006

Chi-Hang Yee , Peter K-F. Chiu , Alex Q. Liu , H.F. Wong , Wilson H.C. Chan , K.L. Lo , C.K. Chan , R. Chan , Carmen CM. Cho , H.Y. Hung , Jeremy Y.C. Teoh , C.F. Ng

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Abstract

Background

Our study reported the outcome of a multimodality focal therapy (FT) cohort for localized primary prostate cancer.

Methods

In a prospective registry all patients underwent magnetic resonance imaging and biopsy (fusion targeted or template biopsy) before FT. Modalities included focal high-intensity focused ultrasound (HIFU), focal cryotherapy, or targeted microwave ablation (TMA). Postoperatively, prostate-specific antigen and functional outcome assessment with validated questionnaires were checked 3 monthly. Magnetic resonance imaging was performed at 1 week, 6 months, and 12 months. Elective prostate biopsy was performed between 6 and 12 months.

Results

A total of 102 patients underwent FT between 2019 and 2024. The cohort consisted of 44 (43.1%) patients for focal HIFU, 18 (17.6%) patients for focal cryotherapy, and 40 (39.2%) patients for TMA. D'Amico low-, intermediate-, and high-risk patients accounted for 31 (30.4%), 66 (64.7%), and 5 (4.9%) patients, respectively. Referring to tumor location, focal HIFU had 38 (86.4%) posterior tumors, focal cryotherapy had 12 (72.2%) anterior tumors, and TMA had 31 (77.5%) anterior tumors. Biopsy data were available for 63 patients (61.8%). Clinically significant recurrence (International Society of Urological Pathology grade group: ≥2) were found in 7 patients (11.1%). Subsequent salvage treatment included the following cases: robotic radical prostatectomy: 2, radiotherapy: 4, and second focal cryotherapy: 1. No deterioration in Expanded Prostate Cancer Index Composite score was observed across all domains before and after the treatment. Improvement in the Urinary Irritative/Obstructive domain was observed in focal cryotherapy (78.3 vs. 91.5, P = 0.011) and TMA (75.7 vs. 84.9, P = 0.019) at 12 months.

Conclusions

Multimodality FT with à la carte approach provides versatility in ablative strategies and offers a reasonable functional and oncological outcome for low- to intermediate-risk prostate cancer.

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前列腺癌的多模式局灶治疗：点菜法在临床实践中的效果

我们的研究报告了局部原发性前列腺癌的多模式局灶治疗（FT）队列的结果。方法在一项前瞻性登记中，所有患者在FT前都接受了磁共振成像和活检（融合靶向或模板活检）。方式包括局灶高强度聚焦超声（HIFU）、局灶冷冻治疗或靶向微波消融（TMA）。术后每3个月检查一次前列腺特异性抗原和功能结果评估。分别于1周、6个月和12个月进行磁共振成像。择期前列腺活检于6 - 12个月间进行。结果2019年至2024年，共有102例患者接受了FT。该队列包括44例（43.1%）局灶HIFU患者，18例（17.6%）局灶冷冻治疗患者和40例（39.2%）TMA患者。D'Amico低、中、高风险患者分别占31例（30.4%）、66例（64.7%）和5例（4.9%）。从肿瘤位置看，HIFU局灶性后路肿瘤38例（86.4%），冷冻局灶性前路肿瘤12例（72.2%），TMA前路肿瘤31例（77.5%）。63例（61.8%）患者获得活检数据。有临床意义的复发（国际泌尿病理学会分级组：≥2级）7例（11.1%）。随后的抢救治疗包括：机器人前列腺根治术2例，放疗4例，二次局灶冷冻治疗1例。前列腺癌扩展指数综合评分在治疗前后均未出现恶化。局部冷冻治疗12个月时尿刺激/梗阻性区改善（78.3 vs 91.5, P = 0.011）， TMA改善（75.7 vs 84.9, P = 0.019）。结论多模式FT结合单点入路为低至中危前列腺癌的消融策略提供了多样性，并提供了合理的功能和肿瘤预后。

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

Prostate International Medicine-Urology

CiteScore

4.40

自引率

26.70%

发文量

审稿时长

35 days

期刊介绍： Prostate International (Prostate Int, PI), the official English-language journal of Asian Pacific Prostate Society (APPS), is an international peer-reviewed academic journal dedicated to basic and clinical studies on prostate cancer, benign prostatic hyperplasia, prostatitis, and ...