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Focal therapy for localized prostate cancer in the era of routine multi-parametric MRI.
Prostate Cancer and Prostatic Diseases ( IF 5.1 ) Pub Date : 2020-02-12 , DOI: 10.1038/s41391-020-0206-6 M J Connor 1, 2 , M A Gorin 3 , H U Ahmed 1, 2 , R Nigam 4, 5
Prostate Cancer and Prostatic Diseases ( IF 5.1 ) Pub Date : 2020-02-12 , DOI: 10.1038/s41391-020-0206-6 M J Connor 1, 2 , M A Gorin 3 , H U Ahmed 1, 2 , R Nigam 4, 5
Affiliation
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BACKGROUND
Prostate cancer focal therapy aims to minimize the side-effects of whole gland treatments, such as radical prostatectomy and radiotherapy without compromising oncological efficacy. However, concerns exist regarding the multifocal nature of prostate cancer and the lack of long-term oncological data for this form of treatment. In recent years, the routine adoption of multi-parametric magnetic resonance imaging (mpMRI) of the prostate has improved our ability to select candidates for focal therapy and to accurately deliver this form of prostate cancer treatment.
METHODS
We performed a review of the literature to provide a summary of the oncological and functional outcomes of men receiving primary prostate focal therapy. Furthermore, we discuss the impact of the routine implementation of mpMRI as part of the initial prostate cancer diagnostic pathway on the selection of candidates and delivery of focal therapy. Finally, we summarize knowledge gaps in the field and highlight active clinical trials in this arena.
RESULTS
Primary focal therapy involves the application of one of a number of energies that ablate tissue, such as cryotherapy and high intensity focused ultrasound (HIFU). Success is principally dependent on highly accurate patient selection and disease localization underpinned in large part by the routine integration of pre-biopsy mpMRI. Prospective medium-term follow-up data for primary HIFU and cryotherapy for men with intermediate-risk disease have shown acceptable cancer control with low risk of side effects and complications. Additional research is needed to clearly define an appropriate follow-up approach and to guide the management of in- and out-of-field recurrences. Multiple comparative trials with randomization against standard care are currently underway in men with intermediate- and high-risk prostate cancer.
CONCLUSION
The widespread adoption of prostate mpMRI has led to improved disease localization, enabling the performance of focal therapy as a viable treatment strategy for men with low volume intermediate-risk prostate cancer.
中文翻译：
常规多参数MRI时代的局限性局部前列腺癌治疗。
背景技术前列腺癌病灶疗法的目的是在不损害肿瘤功效的情况下使全腺疗法如根治性前列腺切除术和放射疗法的副作用最小化。然而，对于前列腺癌的多灶性和缺乏这种治疗形式的长期肿瘤学数据存在担忧。近年来，对前列腺多参数磁共振成像（mpMRI）的常规采用提高了我们选择局部治疗候选者并准确提供这种形式的前列腺癌治疗的能力。方法我们对文献进行了综述，以总结接受原发性前列腺局灶性治疗的男性的肿瘤学和功能结局。此外，我们讨论了作为最初的前列腺癌诊断途径一部分的mpMRI常规实施对候选人的选择和局灶治疗的影响。最后，我们总结了该领域的知识差距，并重点介绍了该领域的积极临床试验。结果一级聚焦治疗涉及消融组织的多种能量之一，例如冷冻疗法和高强度聚焦超声（HIFU）。成功主要取决于高度准确的患者选择和疾病定位，这在很大程度上取决于活检前mpMRI的常规整合。对于中度危险疾病的男性，原发性HIFU和冷冻疗法的前瞻性中期随访数据表明，癌症控制可接受，副作用和并发症的风险较低。需要进行其他研究，以明确定义适当的随访方法，并指导场内外复发的管理。目前正在对中高危前列腺癌男性进行针对标准治疗的随机对照研究。结论前列腺mpMRI的广泛采用导致疾病的定位得到改善，从而使局灶性治疗成为低容量中危前列腺癌男性可行的治疗策略。
更新日期：2020-02-12
中文翻译：
常规多参数MRI时代的局限性局部前列腺癌治疗。
背景技术前列腺癌病灶疗法的目的是在不损害肿瘤功效的情况下使全腺疗法如根治性前列腺切除术和放射疗法的副作用最小化。然而，对于前列腺癌的多灶性和缺乏这种治疗形式的长期肿瘤学数据存在担忧。近年来，对前列腺多参数磁共振成像（mpMRI）的常规采用提高了我们选择局部治疗候选者并准确提供这种形式的前列腺癌治疗的能力。方法我们对文献进行了综述，以总结接受原发性前列腺局灶性治疗的男性的肿瘤学和功能结局。此外，我们讨论了作为最初的前列腺癌诊断途径一部分的mpMRI常规实施对候选人的选择和局灶治疗的影响。最后，我们总结了该领域的知识差距，并重点介绍了该领域的积极临床试验。结果一级聚焦治疗涉及消融组织的多种能量之一，例如冷冻疗法和高强度聚焦超声（HIFU）。成功主要取决于高度准确的患者选择和疾病定位，这在很大程度上取决于活检前mpMRI的常规整合。对于中度危险疾病的男性，原发性HIFU和冷冻疗法的前瞻性中期随访数据表明，癌症控制可接受，副作用和并发症的风险较低。需要进行其他研究，以明确定义适当的随访方法，并指导场内外复发的管理。目前正在对中高危前列腺癌男性进行针对标准治疗的随机对照研究。结论前列腺mpMRI的广泛采用导致疾病的定位得到改善，从而使局灶性治疗成为低容量中危前列腺癌男性可行的治疗策略。
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