Functional outcomes and safety of focal therapy for prostate cancer: a systematic review on results and patient-reported outcome measures (PROMs).

Autor: Nicoletti R; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Alberti A; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Castellani D; Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Yee CH; S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Zhang K; Department of Urology, Beijing United Family Hospital and Clinics, 100015, Beijing, China., Poon DMC; Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China., Chiu PK; S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Campi R; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Resta GR; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Dibilio E; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Pirola GM; Urology Unit, San Giuseppe Hospital, Multimedica Group, Milan, Italy., Chiacchio G; Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy., Fuligni D; Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy., Brocca C; Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy., Giulioni C; Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy., De Stefano V; Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy., Serni S; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Gauhar V; Ng Teng Fong General Hospital (NUHS), Singapore, Singapore., Ng CF; S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Gacci M; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.; Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy., Teoh JYC; S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. jeremyteoh@surgery.cuhk.edu.hk.
Jazyk: angličtina
Zdroj: Prostate cancer and prostatic diseases [Prostate Cancer Prostatic Dis] 2024 Dec; Vol. 27 (4), pp. 614-622. Date of Electronic Publication: 2023 Jul 25.
DOI: 10.1038/s41391-023-00698-8
Abstrakt: Introduction: Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and safety profile than standard whole-gland treatments. Ten different FT modalities have been described in the literature. The objective of our narrative review is to evaluate the safety profile and functional outcomes of these different modalities and the current most used tools of assessment for those outcomes.
Material and Methods: Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole-gland treatments were excluded. All articles reporting functional outcomes were included.
Results: One-hundred-seven studies, reporting data on 6933 patients, were included (26 on High Intensity Focal Ultrasound, 22 on Focal Cryotherapy, 14 on Irreversible Electroporation, 11 on Focal brachytherapy, 10 on Focal Laser Ablation, 8 on Photodynamic Therapy, 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation, 1 on Prostatic Artery Embolization, and 7 studies comparing different FTs). Post-operative pad-free rate ranged between 92.3-100%. Greater heterogeneity exists considering the Change in Erectile Function, with Changing in Erectile function- rates ranging between 0-94.4% (Cryotherapy). The most used Patient-Reported Outcome Measures (PROMs) were the International Prostate Symptom Score and the International Index of Erectile Function for incontinence/urinary function and potency, respectively. The most common reported complications were hematuria, infections, and urethral strictures, with rates widely ranging among different treatments. The Clavien-Dindo Classification was the most used (40/88 papers) to describe adverse events.
Conclusion: FT is a promising treatment for localized PCa, achieving excellent results in terms of safety and functional outcomes. There is a wide heterogeneity in the definition of PROMS and time of collection between studies. High quality comparative studies with standard treatments are needed to reinforce these findings.
(© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)
Databáze: MEDLINE
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