Context

Focal therapy is a promising, minimally invasive strategy to selectively treat localized prostate cancer. A previous systematic review indicated that there is growing evidence for favorable functional outcomes, but that oncological effectiveness was yet to be defined.

Objective

To assess the effectiveness of focal therapy in patients with localized prostate cancer in terms of functional and oncological outcomes.

Evidence acquisition

PubMed, Embase, and The Cochrane Library were searched for studies between October 2015 and December 31, 2020. In addition, the research stages were acquired according to the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations. Ongoing studies were identified through clinical trial registries.

Evidence synthesis

Seventy-two studies were identified exploring eight different sources of energy to deliver focal therapy in 5827 patients. Twenty-seven studies reported on high-intensity focused ultrasound (HIFU), nine studies on irreversible electroporation, 11 on cryoablation, eight on focal laser ablation and focal brachytherapy, seven on photodynamic therapy (PDT), two on radiofrequency ablation, and one on prostatic artery embolization. The majority of studies were prospective development stage 2a studies (n = 357). PDT and HIFU, both in stage 3, showed promising results. Overall, HIFU studies reported a median of 95% pad-free patients and a median of 85% patients with no clinically significant cancer (CSC) in the treated area. For PDT, no changes in continence were reported and a median of 90% of patients were without CSC. Both treatments were well tolerated.

Conclusions

Over the past 5 yr, focal therapy has been studied for eight different energy sources, mostly in single-arm stage 2 studies. Although a first randomized controlled trial in focal therapy has been performed, more high-quality evaluations are needed, preferably via multicenter randomized controlled trials with long-term follow-up and predefined assessment of oncological and functional outcomes and health-related quality-of-life measures.

Patient summary

Focal treatment (FT) of prostate cancer has potential, considering that it has less impact on continence and potency than radical treatment. Our systematic review indicates that despite the method being studied extensively over the past half decade, the majority of studies remain in an early research stage. The techniques high-intensity focused ultrasound and photodynamic therapy have shown most progression toward advanced research stages and show favorable results. However, more high-quality evidence is required before FT can become available as a standard treatment.

中文翻译：

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局部前列腺癌局部治疗的最新系统评价：过去 5 年发生了什么变化？

语境

局部治疗是一种有前途的微创策略，可以选择性地治疗局限性前列腺癌。先前的系统评价表明，越来越多的证据表明有利的功能结果，但尚未确定肿瘤学有效性。

客观的

评估局部前列腺癌患者局部治疗在功能和肿瘤学结果方面的有效性。

取证

PubMed、Embase 和 Cochrane 图书馆在 2015 年 10 月至 2020 年 12 月 31 日期间搜索了研究。此外，研究阶段是根据想法、开发、探索、评估、长期研究 (IDEAL) 建议获得的。通过临床试验注册确定正在进行的研究。

证据综合

确定了 72 项研究，探索 8 种不同的能量来源，为 5827 名患者提供局部治疗。27 项研究报告了高强度聚焦超声 (HIFU)、9 项关于不可逆电穿孔的研究、11 项关于冷冻消融的研究、8 项关于局灶激光消融和局灶近距离放射治疗的研究、7 项关于光动力疗法 (PDT) 的研究、2 项关于射频消融的研究和 1 项关于前列腺动脉栓塞术。大多数研究是前瞻性发展阶段 2a 研究（n = 357)。处于第 3 阶段的 PDT 和 HIFU 均显示出可喜的结果。总体而言，HIFU 研究报告了中位 95% 的无垫患者和中位 85% 的患者在治疗区域没有临床显着癌症 (CSC)。对于 PDT，没有报告尿失禁的变化，中位 90% 的患者没有 CSC。两种治疗均耐受良好。

结论

在过去的 5 年中，针对八种不同的能源进行了局部治疗研究，主要是在单臂 2 期研究中。尽管已经进行了第一次局部治疗的随机对照试验，但仍需要进行更多高质量的评估，最好通过多中心随机对照试验进行，并进行长期随访和预先确定的肿瘤学和功能结果以及与健康相关的质量评估。生活措施。

患者总结

前列腺癌的局部治疗 (FT) 具有潜力，因为与根治性治疗相比，它对节制和效力的影响较小。我们的系统评价表明，尽管该方法在过去五年中得到了广泛的研究，但大多数研究仍处于早期研究阶段。高强度聚焦超声和光动力疗法技术已显示出向高级研究阶段的大部分进展并显示出良好的结果。然而，在 FT 成为标准治疗之前，还需要更多高质量的证据。