摘要
目的探讨MRI实时引导高能聚焦超声消融术(MRgFUS)局灶治疗中低危前列腺癌的可行性及安全性。方法回顾性分析2020年8月至2021年6月北京医院采用MRgFUS治疗的5例中低危局限性前列腺癌患者的临床资料。患者年龄中位值73(53~80)岁,前列腺特异性抗原(PSA)中位值7.34(5.19~8.40)ng/ml,前列腺体积中位值27.96(21.50~37.91)ml。术前国际前列腺症状评分(IPSS)中位值13(0~18)分;3例有保留勃起功能意愿患者术前国际勃起功能问卷(IIEF-15)评分分别为15、23、3分。5例术前穿刺共确诊6处前列腺癌灶,其中国际泌尿病理协会(ISUP)分级分组3组3处,1组3处。临床分期T2a期3例,T2b期2例。所有患者术前接受盆腔MRI检查,高能聚焦超声通过MRI引导消融病灶。术后监测血清PSA、盆腔MRI等评估肿瘤控制情况,采用IPSS、IIEF-15和国际尿失禁协会尿失禁问卷简表(ICI-Q-SF)评估功能学恢复情况。结果本组5例6处病灶中,MRgFUS治疗病灶5处;其中1例有1处MRI阴性病灶为无临床意义前列腺癌,未治疗。术中消融次数中位值8(5~13)次,消融时间中位值64(35~148)min,MRI扫描仪内总治疗时间中位值190(140~355)min。5例术后尿管留置时间中位值1(1~8)d。5例均无严重并发症。5例术后随访时间中位值6(3~12)个月。5例术后PSA均显著下降,最低点PSA分别为1.196、4.398、4.135、1.562、1.350ng/ml,其中4例PSA下降>50%。4例术后3个月行MRI检查,均未见明确前列腺癌病灶。5例末次随访IPSS中位值5(0~14)分,较术前下降;3例有保留勃起功能意愿患者治疗后IIEF-15评分分别为12、30、9分;5例术后均无尿失禁,ICI-Q-SF评分均为0分。结论MRgFUS是治疗中低危局限性前列腺癌安全可行的无创治疗方式,具有良好的功能保护作用和较低的并发症发生率。其肿瘤控制效果还需要大样本临床试验长期随访验证。
Objective To evaluate the feasibility,safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery(MRgFUS)in the treatment of localized prostate cancer(PCa).Methods The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed.The median age was 73(58-80)years,with the median PSA of 7.34(5.19-8.40)ng/ml,and a median prostate volume of 27.96(21.50-37.91)ml.The median pretreatment international prostate symptom score(IPSS)was 13(0-18).Of the 3 patients with intention of erectile function preservation,the pretreatment international index of erectile function-15(IIEF-15)score was 12,23 and 3,respectively.All patients had histopathology-proven PCa of grade group≤International Society of Urological Pathology(ISUP)3,pre-operative PSA level<20 ng/ml,and a clinical stage≤T2b.A total of 6 lesions was confirmed by biopsy,with 3 of ISUP grade group 3 and 3 of ISUP grade group 1.All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging(MRI).PSA,MRI and repeated biopsy were conducted to monitor recurrence.Questionnaires consisted of IPSS,IIEF-15,and the International Consultation on Incontinence-questionnaire-Short Form(ICI-Q-SF)were recorded before and after MRgFUS to evaluate the impact on functional preservation.Results A total of 5 patients received MRgFUS.In total,5 of the 6 lesions were treated.1 lesion unvisible on MRI was not clinically significant and was left untreated.The median time in MRI scanner was 190(140-355)min,and the median sonication time was 64(35-148)min with the median sonications of 8(5-13).The median catheter indwelling time was 1(1-8)days.No other adverse effects were reported.The PSA level of all 5 patients decreased,with the nadir PSA of 1.196 ng/ml,4.398 ng/ml,4.135 ng/ml,1.562ng/ml and 1.350ng/ml,respectively.4 of the patients had a PSA decrease over 50%.No PCa lesion was seen on MRI at 3-month follow-up visit.As for functional preservation,the post-MRgFUS IPSS declined compared with the baseline score,and the IPSS of last follow-up was 5(0-14).Of the 3 patients with intention to preserve the erectile function,the erectile function score of IIEF-15 were 12,30 and 9 three months after the treatment,respectively.No incontinence occurred postoperatively.Conclusions MRgFUS is a feasible and safe way for the treatment of low-to intermediate-risk localized PCa,with satisfactory performance on functional preservation and low incidence of complications.The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.
作者
王淼
侯惠民
谷涛
沈承
王萱
王建龙
田子健
孟令峰
张磊
张金涛
丁鑫
王建业
刘明
Wang Miao;Hou Huimin;Gu Tao;Shen Cheng;Wang Xuan;Wang Jianlong;Tian Zijian;Meng Lingfeng;Zhang Lei;Zhang Jintao;Ding Xin;Wang Jianye;Liu Ming(Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第11期824-829,共6页
Chinese Journal of Urology
基金
中央高校基本科研业务费专项资金(3332019122、3332020069)。
关键词
前列腺肿瘤
局灶治疗
磁共振引导手术
疗效
安全性
Prostate neoplasm
Focal therapy
Magnetic resonance guided surgery
Efficacy
Safety
