目的:评估12个月随访后经会阴激光消融(TPLA)作为局部前列腺癌(PCa)局部治疗的肿瘤和功能结局。
方法:在2021年7月至2022年12月期间,对患有低风险和中风险局限性PCa的患者进行前瞻性TPLA治疗。纳入标准如下:临床分期结果:24例患者接受局灶性TPLA。基线特征为年龄[中位数67岁(IQR12)],PSA[5.7ng/mL(3.9)],PVol[49mL(27)],CCI[0(0)],IPSS[11(9)],IPSS-QoL[2(2)],IIEF-5[21(6)],ICIQ-SF[0(7)],MSHQ-EjD射精域[14(4)]和打扰评分[0(2)]。中位手术时间为34分钟(IQR12)。TPLA后6h的视觉模拟评分中位数(VAS)为0(IQR1)。所有患者的术后疗程都是正常的,他们在术后第二天出院,在术后第七天接受导管拔除。没有患者在拔除导管时出现尿失禁。PSA显着降低(p=0.01)和IPSS改善(p=0.009),在3个月的随访中观察到与基线相比的IPSS-QoL(p=0.02)和ICIQ-SF评分(p=0.04)。在随访期间,勃起和射精功能未显示任何显着变化。没有记录到术中和围手术期并发症。记录了3例Clavien-Dindo术后并发症(12%):1级(2例尿潴留)和2级(1例尿路感染)。在12个月的随访中,8例患者显示与可疑复发性疾病相关的mpMRI图像(PIRADSv2.1≥3).重新活检后,7/24患者(29%)的结果在组织学上证实为PCa,其中3例在治疗的病变中复发(12.5%)。成功率为87.5%。
结论:局灶性TPLA肿瘤和功能结果似乎令人鼓舞。TPLA是保险箱,无痛,和有效的技术,并能很好地保存失禁和性结果。12个月的复发率约为12.5%。
OBJECTIVE: To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up.
METHODS: Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson\'s Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up.
RESULTS: Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients\' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%.
CONCLUSIONS: The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.