Del diagnóstico a la ablación: el papel de la terapia focal para el cáncer de próstata localizado

IF 1.7 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI:10.1016/j.acuro.2025.501918

R. Roldan-Testillano , L. Rodriguez-Sanchez , M.E. Rodríguez Socarrás , G. de Andrés Boville , F. Durazo-Ruiz , J. Gómez Rivas , H. Alfambra Fernández , J. Sánchez Macías , F.J. Bianco , B. Miñana López , R. Sanchez-Salas

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引用次数: 0

Abstract

Introduction

Focal therapy (FT) has emerged as an intermediate therapeutic strategy between active surveillance (AS) and radical treatments for the management of localized prostate cancer (PCa) in patients with clinically significant disease and a well-defined index lesion (IL). The development of ablative and imaging techniques has enabled the selective treatment of the IL, preserving healthy tissue and reducing adverse effects.

Objectives

o review the current evidence on FT in localized PCa, including technological modalities, selection criteria, diagnostic tools, post-treatment surveillance strategies, and barriers to its clinical implementation in the Spanish healthcare setting.

Materials and methods

A structured narrative review was conducted through a search in PubMed, Scopus, and Web of Science, including studies published up to April 2025. Original articles, reviews, clinical guidelines, and meta-analyses focusing on FT for localized PCa were selected. Prospective and comparative studies addressing oncological and functional outcomes, as well as associated technologies such as fusion biopsy, multiparametric magnetic resonance imaging (mpMRI), prostate-specific membrane antigen positron emission tomography (PSMA-PET), and artificial intelligence (AI), were prioritized.

Results

FT offers encouraging short- and medium-term oncological outcomes, with notable functional preservation. Modalities such as high-intensity focused ultrasound (HIFU) and cryotherapy are currently the most widely used and have the longest clinical trajectory, while irreversible electroporation (IRE) stands out among emerging techniques with results.

Surveillance after FT should be multifactorial and include serial PSA monitoring, systematic and targeted biopsies, as well as imaging techniques such as mpMRI. Specific tools such as PI-FAB (Prostate Imaging after Focal Ablation) and TARGET (Transatlantic Recommendations for MRI Evaluation after Focal Therapy) systems allow for standardized interpretation of mpMRI after FT. In Spain, its adoption remains limited, reinforcing the need for specific guidelines and multicenter registries.

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从诊断到切除：局部前列腺癌靶向治疗的作用

局灶治疗（FT）已成为一种介于主动监测（as）和根治性治疗之间的中间治疗策略，用于治疗具有临床意义的疾病和明确的指数病变（IL）的局限性前列腺癌（PCa）患者。消融和成像技术的发展使得选择性治疗IL，保留健康组织和减少不良反应成为可能。目的：回顾目前关于局部PCa中FT的证据，包括技术模式、选择标准、诊断工具、治疗后监测策略以及在西班牙医疗机构中临床实施的障碍。材料和方法通过检索PubMed、Scopus和Web of Science，包括截至2025年4月发表的研究，进行了结构化的叙述性回顾。我们选择了聚焦于FT治疗局限性PCa的原创文章、综述、临床指南和荟萃分析。优先考虑肿瘤和功能结果的前瞻性和比较研究，以及融合活检、多参数磁共振成像（mpMRI）、前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）和人工智能（AI）等相关技术。结果ft提供了令人鼓舞的短期和中期肿瘤预后，并具有显著的功能保存。高强度聚焦超声（HIFU）和冷冻治疗是目前应用最广泛、临床发展时间最长的治疗方法，而不可逆电穿孔（IRE）则是新兴技术中最具成效的。FT后的监测应该是多因素的，包括连续PSA监测、系统和有针对性的活检，以及mpMRI等成像技术。特定的工具，如PI-FAB（局灶消融后前列腺成像）和TARGET（局灶治疗后MRI评估跨大西洋建议）系统允许对FT后mpMRI进行标准化解释。在西班牙，其采用仍然有限，加强了对特定指南和多中心登记的需求。

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

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.