Introduction and objectives: 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. Materials and 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%.
引言与目的：本研究旨在评估经会阴激光消融术作为局限性前列腺癌局部治疗方式，在12个月随访期内的肿瘤学及功能学结局。材料与方法：前瞻性纳入2021年7月至2022年12月期间接受局部TPLA治疗的低危及中危局限性前列腺癌患者。纳入标准包括：临床分期＜T2b；PSA＜20 ng/mL；国际泌尿病理学会分级≤2；经MRI融合活检确认PI-RADS v2.1评分≥3的病灶。收集术中、围术期及术后数据。在基线期及TPLA术后3、6、12个月分别记录年龄、PSA、前列腺体积、查尔森合并症指数、国际前列腺症状评分及生活质量评分、国际勃起功能指数-5、国际尿失禁咨询委员会尿失禁问卷简表、男性性健康问卷-射精功能障碍简表等变量。术后3个月及12个月行多参数MRI检查，所有患者在12个月时接受融合引导下前列腺重复活检。技术成功定义为12个月随访时治疗靶病灶无复发。结果：共24例患者接受局部TPLA治疗。基线特征为：年龄[中位数67岁（四分位距12）]、PSA[5.7 ng/mL（3.9）]、前列腺体积[49 mL（27）]、查尔森合并症指数[0（0）]、国际前列腺症状评分[11（9）]、生活质量评分[2（2）]、国际勃起功能指数-5[21（6）]、国际尿失禁咨询委员会尿失禁问卷简表[0（7）]、男性性健康问卷射精功能域[14（4）]及困扰评分[0（2）]。中位手术时间34分钟（四分位距12）。术后6小时视觉模拟评分中位值为0（四分位距1）。所有患者术后恢复顺利，均于术后第2日出院，术后第7日拔除导尿管，拔管时均无尿失禁发生。3个月随访时观察到PSA显著降低（p=0.01），国际前列腺症状评分（p=0.009）、生活质量评分（p=0.02）及国际尿失禁咨询委员会尿失禁问卷简表评分（p=0.04）较基线显著改善。勃起与射精功能在随访期间未见显著变化。未记录术中及围术期并发症。术后发生3例Clavien-Dindo分级并发症（12%）：1级2例（尿潴留），2级1例（尿路感染）。12个月随访时，8例患者多参数MRI提示可疑复发（PI-RADS v2.1≥3）。重复活检后，7/24例（29%）经组织学证实为前列腺癌，其中3例为治疗病灶内复发（12.5%），技术成功率达87.5%。结论：局部TPLA治疗的肿瘤学与功能学结果令人鼓舞。该技术安全、无痛且有效，能良好保留控尿功能与性功能，12个月复发率约为12.5%。
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