Abstract：
BACKGROUND: High-intensity focused ultrasound (HIFU) is regarded as a promising alternative treatment option for localized prostate cancer (PCa) as it has been proposed to offer similar oncologic control to the standard of care, but with significantly reduced treatment-related side effects. This systematic literature review assesses the available evidence of whole-gland HIFU as primary treatment for localized PCa.
METHODS: MEDLINE (PubMed) was searched for studies investigating oncological and functional outcomes following whole-gland HIFU as primary treatment for localized PCa. Our primary outcomes for the review were biochemical disease-free survival rates (BDFS), overall and PCa-specific survival rates as well as negative biopsy rates. Our secondary outcomes were functional results and complications of the treatment.
RESULTS: A total of 375 articles were identified, of which 35 were included in the present review. All 35 articles were prospective or retrospective case series. Mean/median duration of follow-up across studies was 10.9 to 94 months, and 6618 patients were included in the review. The BDFS rate varied greatly across studies from 21.7% to 89.2% during follow-up. The 10-year PCa-specific survival rate following HIFU was 90%, 99%, and 100% in 3 studies. Negative biopsy rates post-HIFU ranged from 20% to 92.7% across studies. Common side effects to HIFU included urinary incontinence (grade 1: 0%-22.7%), erectile dysfunction (11.6%-77.1%), urinary tract infections (1.5%-47.9%), and bladder outlet obstruction mainly as urethral strictures (7%-41.2%).
CONCLUSIONS: Great variation in oncological and functional outcomes was seen across studies. More prospective trials are needed before whole-gland HIFU can be considered as a treatment option for localized PCa.
METHODS: MEDLINE (PubMed) was searched for studies investigating oncological and functional outcomes following whole-gland HIFU as primary treatment for localized PCa. Our primary outcomes for the review were biochemical disease-free survival rates (BDFS), overall and PCa-specific survival rates as well as negative biopsy rates. Our secondary outcomes were functional results and complications of the treatment.
RESULTS: A total of 375 articles were identified, of which 35 were included in the present review. All 35 articles were prospective or retrospective case series. Mean/median duration of follow-up across studies was 10.9 to 94 months, and 6618 patients were included in the review. The BDFS rate varied greatly across studies from 21.7% to 89.2% during follow-up. The 10-year PCa-specific survival rate following HIFU was 90%, 99%, and 100% in 3 studies. Negative biopsy rates post-HIFU ranged from 20% to 92.7% across studies. Common side effects to HIFU included urinary incontinence (grade 1: 0%-22.7%), erectile dysfunction (11.6%-77.1%), urinary tract infections (1.5%-47.9%), and bladder outlet obstruction mainly as urethral strictures (7%-41.2%).
CONCLUSIONS: Great variation in oncological and functional outcomes was seen across studies. More prospective trials are needed before whole-gland HIFU can be considered as a treatment option for localized PCa.
摘要：
背景：高强度聚焦超声（HIFU）被认为是局部前列腺癌（PCa）的一种有希望的替代治疗选择，因为它已被提议提供与护理标准相似的肿瘤控制，但与治疗相关的副作用显着减少。本系统文献综述评估了全腺HIFU作为局部PCa主要治疗方法的现有证据。
方法：搜索MEDLINE（PubMed）研究全腺体HIFU作为局部PCa的主要治疗后肿瘤和功能结局。我们审查的主要结果是生化无病生存率（BDFS），总体生存率和PCa特异性生存率以及阴性活检率。我们的次要结果是治疗的功能结果和并发症。
结果：共确定了375篇文章，其中35人被列入本审查。所有35篇文章均为前瞻性或回顾性病例系列。所有研究的平均/中位随访时间为10.9至94个月，6618例患者被纳入审查。在随访期间，BDFS率在研究中差异很大，从21.7%到89.2%。HIFU后的10年PCa特异性生存率为90％，99%,在3项研究中占100％。在整个研究中，HIFU后的阴性活检率为20％至92.7％。HIFU的常见副作用包括尿失禁（1级：0％-22.7％），勃起功能障碍（11.6%-77.1%），尿路感染（1.5%-47.9%），膀胱出口梗阻主要表现为尿道狭窄(7%-41.2%)。
结论：在整个研究中观察到肿瘤和功能结局的巨大差异。在全腺体HIFU可以被认为是局部PCa的治疗选择之前，需要更多的前瞻性试验。
方法：搜索MEDLINE（PubMed）研究全腺体HIFU作为局部PCa的主要治疗后肿瘤和功能结局。我们审查的主要结果是生化无病生存率（BDFS），总体生存率和PCa特异性生存率以及阴性活检率。我们的次要结果是治疗的功能结果和并发症。
结果：共确定了375篇文章，其中35人被列入本审查。所有35篇文章均为前瞻性或回顾性病例系列。所有研究的平均/中位随访时间为10.9至94个月，6618例患者被纳入审查。在随访期间，BDFS率在研究中差异很大，从21.7%到89.2%。HIFU后的10年PCa特异性生存率为90％，99%,在3项研究中占100％。在整个研究中，HIFU后的阴性活检率为20％至92.7％。HIFU的常见副作用包括尿失禁（1级：0％-22.7％），勃起功能障碍（11.6%-77.1%），尿路感染（1.5%-47.9%），膀胱出口梗阻主要表现为尿道狭窄(7%-41.2%)。
结论：在整个研究中观察到肿瘤和功能结局的巨大差异。在全腺体HIFU可以被认为是局部PCa的治疗选择之前，需要更多的前瞻性试验。
