Home > Journals > Minerva Urologica e Nefrologica > Past Issues > Minerva Urologica e Nefrologica 2018 June;70(3) > Minerva Urologica e Nefrologica 2018 June;70(3):252-63

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as

 

REVIEW   

Minerva Urologica e Nefrologica 2018 June;70(3):252-63

DOI: 10.23736/S0393-2249.18.03094-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

New technologies and techniques for prostate cancer focal therapy

Estefanía LINARES-ESPINÓS 1, 2, Arie CARNEIRO 3, Juan I. MARTÍNEZ-SALAMANCA 2, 4, Fernando BIANCO 2, 5, Adalberto CASTRO-ALFARO 6, Xavier CATHELINEAU 6, Massimo VALERIO 7, Rafael SANCHEZ-SALAS 6

1 Department of Urology, University Hospital La Paz, Madrid, Spain; 2 Lyx Institute of Urology - Focalyx, Madrid, Spain; 3 Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil; 4 Department of Urology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain; 5 Urological Research Network, Nova University, Miami, FL, USA; 6 Department of Urology, L’Institut Mutualiste Montsouris, Paris, France; 7 Deparment of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland


PDF


INTRODUCTION: The aim of this study was to review the oncological and functional outcomes of new and established primary focal treatments (FT) for localized prostate cancer (PCa).
EVIDENCE ACQUISITION: We performed a systematic search of published studies on FT for localized PCa using electronic databases (Medline and Embase). These studies included reports on hemi-ablation, focal ablation and target-ablation. We excluded salvage focal therapy studies and limited the search to those with a minimum of 12 months of follow-up.
EVIDENCE SYNTHESIS: We selected 20 studies with a total of 2523 patients who were treated in the primary setting. The energy sources used were cryotherapy (8), high-intensity focused ultrasound (9), irreversible electroporation (1), photodynamic therapy (1) and focused laser ablation (1), with 65% hemiablation, 25% focal ablation and 10% target-ablation. The median follow-ups ranged from 6 to 44.4 months. Mean age was 60.4-70 years and mean prostate-specific antigen was 4.4-<10 ng/dL; 26-100% had a Gleason Score of 6, and 0-65% had a Gleason Score of 7. Patient selection was carried out by TRUS biopsy in 9 studies, while transperineal template mapping biopsy and mp-MRI were employed in six and 13 studies, respectively. The overall post-treatment positive biopsy rate was 1.2-51% with 1.6-32% patients having a residual disease in the treated area. The post-treatment continence rates were 90-100%, and the rates of erectile dysfunction ranged from 0-53.2%.
CONCLUSIONS: Reliable evidence for the partial-gland treatment of PCa is increasing, and encouraging mid-term oncologic outcomes with the preservation of sexual and urinary functions have been reported. Accurate patient selection at the outset of treatment and careful follow-up seem key attributes to achieve excellent functional results and encouraging oncological outcomes.


KEY WORDS: Prostatic neoplasms - Cryotherapy - High-intensity focused ultrasound ablation - Electroporation - Photochemotherapy

top of page